Organization
DIVINE HEALTHCARE AGENCY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA AJIBOLA (PRESIDENT)
(407) 791-0093
Entity
Organization
Contact information
Practice address
421 W VINE ST, KISSIMMEE, FL 34741-4154
(407) 724-1517
Mailing address
421 W VINE ST, KISSIMMEE, FL 34741-4154
(407) 724-1517
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
01/29/2019
Last updated
01/29/2019
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