Divine Edge Health Services LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

DIVINE EDGE HEALTH SERVICES LLC

Practice address

3008 E Hebron Pkwy BLDG 500
Carrollton, TX 75010-4470

Phone

(214) 493-3118

Fax

(888) 958-2383

NPI assigned

May 2, 2008

Organization subpart

No

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

Authorized official

Name

Oluyemisi Akinode, REGISTERED NURSE

Title

Administrator

Phone

(214) 493-3118

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Home health agency certification: CCN 747372

Legal name

DIVINE EDGE HEALTH SERVICES LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

May 24, 2010

Last certification

Feb 12, 2021

Ownership / control type

Proprietary

Organization structure

LLCProprietary

Incorporated

Jan 11, 2008 in TX

Enrollment address

3008 E Hebron Pkwy
BLDG 500
Carrollton, TX 75010-4470

Listed as

Divine Edge Health Services LLCCCN 747372 · All quality measures

Ownership

Proprietary

Certified

May 24, 2010

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

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

{
    "created_epoch": "1209686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1548436207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3008 E HEBRON PKWY BLDG 500",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104470",
            "telephone_number": "214-493-3118",
            "fax_number": "888-958-2383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3008 E HEBRON PKWY BLDG 500",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104470",
            "telephone_number": "214-493-3118",
            "fax_number": "888-958-2383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE EDGE HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-02",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "AKINODE",
        "authorized_official_first_name": "OLUYEMISI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "214-493-3118",
        "authorized_official_credential": "REGISTERED NURSE"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Dirdack, FNP-C
• Vincent Dirusso, DDS
• Jason Diu
• Dalton Divakaran
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• Divine Mental Wellness PLLC
• DLRC Ancillary Services, LLC
• DLS Rehab Services Inc.
• DMM Lab LLC
• Matthew Tuan Doan

• Home Health Agency in Carrollton, TX
• Providers in Carrollton, TX by specialty
• Home Health Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.