Organization
DIVINE SOURCE CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SYDNEY GORDON (ADMINISTRATIVE)
(317) 499-2757
Entity
Organization
Contact information
Practice address
1547 W OAK ST, ZIONSVILLE, IN 46077-1840
(800) 337-4491
Mailing address
1547 W OAK ST, ZIONSVILLE, IN 46077-1840
(800) 337-4491
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
3747A0650X
Attendant Care Provider
—
—
Other
Enumeration date
08/05/2024
Last updated
06/02/2025
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