Divinity Home Healthcare, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

DIVINITY HOME HEALTHCARE, LLC

Practice address

1734 Kingsley Ave Ste 3
Orange Park, FL 32073-4418

Phone

(904) 900-8073

NPI assigned

Jul 15, 2016

Last updated

Mar 23, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gert Louis

Title

Ambr

Phone

(561) 543-1498

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679529600000",
    "number": "1093168924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3829 CARDINAL OAKS CIR",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320654251",
            "telephone_number": "561-543-1498",
            "fax_number": "904-900-8113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1734 KINGSLEY AVE STE 3",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734418",
            "telephone_number": "904-900-8073"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5700 Lake Worth Rd Ste 305B",
            "address_purpose": "LOCATION",
            "city": "Greenacres",
            "state": "FL",
            "postal_code": "334633278",
            "country_code": "US",
            "telephone_number": "561-909-9027",
            "fax_number": "561-290-6026",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1516 Patrick Way",
            "address_purpose": "LOCATION",
            "city": "Greenacres",
            "state": "FL",
            "postal_code": "334133319",
            "country_code": "US",
            "telephone_number": "561-543-1498",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DIVINITY HOME HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-15",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A",
        "authorized_official_last_name": "LOUIS",
        "authorized_official_first_name": "GERT",
        "authorized_official_title_or_position": "AMBR",
        "authorized_official_telephone_number": "561-543-1498"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093168924",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.