NPIMap

Organization Active NPI

Divine Health Services LLC

  • Home Health Agency
  • Zapata, TX
National Provider Identifier
1255104485
Registry record updated Feb 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
DIVINE HEALTH SERVICES LLC
Practice address
124 S US Highway 83 Unit 8, Zapata, TX 78076-3813
Zapata, TX 78076
Phone
(956) 750-6592
NPI assigned
Oct 31, 2023
Last updated
Feb 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2025

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

Authorized official

Name
Mr. Emmanuel Eduardo ElizondoNPI 1750162921
Title
Owner
Phone
(956) 750-6592

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary
Community Based Hospice Care Agency 251G00000X
Personal Care Attendant 3747P1801X

Addresses

Primary practice location

124 S US Highway 83 Unit 8, Zapata, TX 78076-3813
Zapata, TX 78076

Mailing address

124 S US Highway 83 Unit 8, Zapata, TX 78076-3813
Zapata, TX 78076
Phone (956) 265-9075

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240712000732 TX Part A Provider - Home Health Agency 8022553262 Practice locations: Zapata, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255104485. Details of each certification follow.

Home health agency certification: CCN 748125

Legal name
DIVINE HEALTH SERVICES LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Aug 21, 2024
Last certification
Aug 1, 2024
Organization structure
LLCProprietary
Enrollment address
124 S US Highway 83
Unit 8
Zapata, TX 78076-3813

Care Compare: Home health agency

Medicare Care Compare
Listed as
Divine Health Services LLCCCN 748125 · All quality measures
Overall star rating
1.5 of 5
Ownership
-
Certified
Aug 21, 2024
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

124 S US Highway 83
Ste 8
Zapata, TX 78076
Phone (956) 750-6592

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Emmanuel Elizondo Individual 5% Or Greater Direct Ownership Interest Oct 5, 2023 50%
Limited Partnership InterestPresident Oct 5, 2023 50%
Corporate Officer Oct 5, 2023 50%
Corporate Director Oct 5, 2023 50%
W-2 Managing Employee Oct 5, 2023
Jamie Gutierrez Individual 5% Or Greater Direct Ownership Interest Oct 5, 2023 50%
Limited Partnership InterestVice President Oct 5, 2023 50%
Corporate Officer Oct 5, 2023 50%
Corporate Director Oct 5, 2023 50%
W-2 Managing Employee Oct 5, 2023

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1698710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740355200000",
    "number": "1255104485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 S US HIGHWAY 83 UNIT 8, ZAPATA, TX 78076-3813",
            "city": "ZAPATA",
            "state": "TX",
            "postal_code": "78076",
            "telephone_number": "956-265-9075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 S US HIGHWAY 83 UNIT 8, ZAPATA, TX 78076-3813",
            "city": "ZAPATA",
            "state": "TX",
            "postal_code": "78076",
            "telephone_number": "956-750-6592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-31",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A",
        "authorized_official_last_name": "ELIZONDO",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_middle_name": "EDUARDO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "956-750-6592",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Zapata, TX

Sources for this page

Verify at the official NPI Registry.