# DIVINE HOMECARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659779536
- **Authorized official:** MUSTAK RAHMAN MBBS,CPC,CPC-H (MANAGER)
- **Authorized official phone:** (732) 567-7797

## Contact information

- **Practice address:** 71 ANNAPOLIS ST, TINTON FALLS, NJ 07712-3175
- **Practice address phone:** (732) 567-7797
- **Practice address fax:** (888) 685-8722
- **Mailing address:** 71 ANNAPOLIS ST, TINTON FALLS, NJ 07712-3175
- **Mailing address phone:** (732) 567-7797
- **Mailing address fax:** (888) 685-8722

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | — |
| 251F00000X | Home Infusion Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NJ | Yes |

## Other

- **Enumeration date:** 12/09/2014
- **Last updated:** 12/09/2014