Organization
DIVINE HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERRICK O TILLER (OWNER)
(334) 405-5881
Entity
Organization
Contact information
Practice address
802 GRANT ST APT 3, DOTHAN, AL 36301-3807
(334) 405-5881
Mailing address
802 GRANT ST APT 3, DOTHAN, AL 36301-3807
(334) 405-5881
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
08/27/2014
Last updated
08/27/2014
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