Organization
PURE DIVINE INDEPENDENT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY GREEN (CHIEF EXECUTIVE OFFICER)
(931) 367-4430
Entity
Organization
Contact information
Practice address
1860 WILMA RUDOLPH BLVD # 126P, CLARKSVILLE, TN 37040-6750
(931) 367-4430
Mailing address
1960 MADISON ST STE J178, CLARKSVILLE, TN 37043-8063
(615) 346-5558
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
02/05/2024
Last updated
08/29/2024
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