Organization
DIVINE INNOVATION SERVICES LLC
Active
Other names
Divine Innovation Services
Organization subpart
No
Provider details
NPI number
Authorized official
TRACIE LANAE PEARSALL (ADMINISTRATOR)
(919) 675-8937
Entity
Organization
Contact information
Practice address
120 CAPCOM AVE STE 102B, WAKE FOREST, NC 27587-6537
(919) 675-8937
Mailing address
12400 WAKE UNION CHURCH RD # 3-256, WAKE FOREST, NC 27587-4509
(919) 675-8937
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
385H00000X
Respite Care
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
01/19/2024
Last updated
04/29/2025
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