# DIVINE SENIOR HOME CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Divine Senior Home Care LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841707213
- **Authorized official:** BUSHRA CHAUDHARY (ADMINISTRATOR)
- **Authorized official phone:** (703) 677-0506

## Contact information

- **Practice address:** 17300 RIVER RIDGE BLVD STE 202A, WOODBRIDGE, VA 22191-5168
- **Practice address phone:** (703) 677-0506
- **Mailing address:** 17300 RIVER RIDGE BLVD STE 202A, WOODBRIDGE, VA 22191-5168
- **Mailing address phone:** (703) 677-0506

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | HCO-1790 | VA | Yes |

## Other

- **Enumeration date:** 01/05/2018
- **Last updated:** 01/05/2018