Pure Divine Independent Care LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

PURE DIVINE INDEPENDENT CARE LLC

Practice address

1860 Wilma Rudolph Blvd # 126P
Clarksville, TN 37040-6750

Phone

(931) 367-4430

NPI assigned

Feb 5, 2024

Organization subpart

No

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

Authorized official

Name

Tiffany Green

Title

Chief Executive Officer

Phone

(931) 367-4430

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1707091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724889600000",
    "number": "1124881966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1960 MADISON ST STE J178",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370438063",
            "telephone_number": "615-346-5558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 WILMA RUDOLPH BLVD # 126P",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370406750",
            "telephone_number": "931-367-4430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURE DIVINE INDEPENDENT CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-05",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "931-367-4430"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2024; 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.