Organization
DIVINE SENIOR HOME CARE LLC
Active
Other names
Divine Senior Home Care LLC
Organization subpart
No
Provider details
NPI number
Authorized official
BUSHRA CHAUDHARY (ADMINISTRATOR)
(703) 677-0506
Entity
Organization
Contact information
Practice address
17300 RIVER RIDGE BLVD STE 202A, WOODBRIDGE, VA 22191-5168
(703) 677-0506
Mailing address
17300 RIVER RIDGE BLVD STE 202A, WOODBRIDGE, VA 22191-5168
(703) 677-0506
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
HCO-1790
VA
Other
Enumeration date
01/05/2018
Last updated
01/05/2018
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