Organization
DIVINE HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NAKIA CASSELL BENNETT LPN (OWNER)
(601) 896-2449
Entity
Organization
Contact information
Practice address
3840 MIDDLE RD, EDWARDS, MS 39066-9691
(601) 896-2449
Mailing address
3840 MIDDLE RD, EDWARDS, MS 39066-9691
(601) 896-2449
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
P318307
MS
Other
Enumeration date
11/24/2012
Last updated
11/24/2012
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