Organization
JOHNSON DIAGNOSTIC LLC
Active
Parent organization
JOHNSON DIAGNOSTIC LLC
Other names
Divine Home Care Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
JOHNSON DIAGNOSTIC LLC
Authorized official
WANKETHIA JOHNSON (CEO)
(833) 385-3874
Entity
Organization
Contact information
Practice address
121 FRONT STREET, PURVIS, MS 39475
(833) 385-3874
(601) 861-4433
Mailing address
121 FRONT STREET, PURVIS, MS 39475
(833) 385-3874
(601) 861-4433
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251F00000X
Home Infusion Agency
—
—
251J00000X
Nursing Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
06/11/2025
Last updated
06/11/2025
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