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Organization

DIVINE 4 SUPPORT LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MONIQUE BOYD (OWNER)
(313) 477-9642
Entity
Organization

Contact information

Practice address
15378 VERONICA AVE, EASTPOINTE, MI 48021-3636
(313) 477-9642
(313) 521-3767
Mailing address
15378 VERONICA AVE, EASTPOINTE, MI 48021-3636
(313) 477-9642
(313) 521-3767

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
251E00000X
Home Health Agency
3747A0650X
Attendant Care Provider
3747P1801X
Personal Care Attendant
374U00000X
Home Health Aide
Primary
376G00000X
Nursing Home Administrator

Other

Enumeration date
11/06/2023
Last updated
01/10/2025
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