Organization
DVINE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL EDWARDS (ADMINISTRATOR)
(601) 810-5788
Entity
Organization
Contact information
Practice address
2102 TRADEWIND DR, SUITE 172, MESQUITE, TX 75150-3309
(601) 810-5788
Mailing address
1017 HANEY RD. SUITE.C, SUMMIT, MS 39666
(601) 810-5788
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
MS
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
10/02/2009
Last updated
01/30/2012
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