Organization
DIVINE CARE
Active
Other names
The Divine Care
Organization subpart
No
Provider details
NPI number
Authorized official
MERCEDES MCQUEEN (ADMINISTRATOR)
(817) 412-3956
Entity
Organization
Contact information
Practice address
215 EXECUTIVE WAY, 130, DESOTO, TX 75115-2396
(972) 947-3100
(972) 947-3099
Mailing address
215 EXECUTIVE WAY, 130, DESOTO, TX 75115-2396
(972) 947-3100
(972) 947-3099
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
016265
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016265
LICENSED HOME HEALTH SERVICES, PERSONAL CARE SERVICES
TX
Enumeration date
10/01/2015
Last updated
10/01/2015
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