Organization
DIVINITY HOME HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERT LOUIS (AMBR)
(561) 543-1498
Entity
Organization
Contact information
Practice address
1734 KINGSLEY AVE STE 3, ORANGE PARK, FL 32073-4418
(904) 900-8073
Mailing address
3829 CARDINAL OAKS CIR, ORANGE PARK, FL 32065-4251
(561) 543-1498
(904) 900-8113
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093168924
—
FL
Enumeration date
07/15/2016
Last updated
03/23/2023
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