Organization
DIVINE HEALTHCARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTUS GICHABA (OWNER)
(678) 371-2657
Entity
Organization
Contact information
Practice address
4343 DALE BLVD, WOODBRIDGE, VA 22193-2401
(678) 371-2657
Mailing address
15320 WITS END DR, WOODBRIDGE, VA 22193-5889
(678) 371-2657
Taxonomy
Speciality
Code
Description
License number
State
364SH0200X
Home Health Clinical Nurse Specialist
—
—
374U00000X
Home Health Aide
Primary
—
—
376G00000X
Nursing Home Administrator
—
—
Other
Enumeration date
02/09/2022
Last updated
02/09/2022
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