Organization
DIVINE LIVING PERSONAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LECRESHIA HENDERSON (CEO)
(800) 613-0781
Entity
Organization
Contact information
Practice address
2600 S SHORE BLVD STE 300, LEAGUE CITY, TX 77573-2944
(800) 613-0781
Mailing address
2600 S SHORE BLVD STE 300, LEAGUE CITY, TX 77573-2944
(800) 613-0781
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
372600000X
Adult Companion
—
—
3747P1801X
Personal Care Attendant
—
—
374U00000X
Home Health Aide
—
—
376J00000X
Homemaker
—
—
376K00000X
Nurse's Aide
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HOMECARE
COMPANION
TX
Enumeration date
09/22/2022
Last updated
01/25/2023
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