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Organization
DIVINE INNOVATION SERVICES LLC
Active
Organization
DIVINE INNOVATION SERVICES LLC
Active
Other names
Divine Innovation Services
Organization subpart
No
Provider details
NPI number
Authorized official
TRACIE LANAE PEARSALL (ADMINISTRATOR)
(919) 675-8937
Entity
Organization
Contact information
Practice address
120 CAPCOM AVE STE 102B, WAKE FOREST, NC 27587-6537
(919) 675-8937
Mailing address
12400 WAKE UNION CHURCH RD # 3-256, WAKE FOREST, NC 27587-4509
(919) 675-8937
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
385H00000X
Respite Care
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
01/19/2024
Last updated
04/29/2025
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