Organization
DIVINELY CHOSEN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEONDRA BURCH (OWNER)
(352) 602-5541
Entity
Organization
Contact information
Practice address
797 TEAGUE TRL APT 13207, LADY LAKE, FL 32159-3152
(352) 602-5541
Mailing address
797 TEAGUE TRL APT 13207, LADY LAKE, FL 32159-3152
(352) 602-5541
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
02/14/2018
Last updated
02/14/2018
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