Divine Healthcare Services LLC

Primary specialty

Home Health AideTaxonomy code 374U00000X

Legal business name

DIVINE HEALTHCARE SERVICES LLC

Practice address

4343 Dale Blvd
Woodbridge, VA 22193-2401

Phone

(678) 371-2657

NPI assigned

Feb 9, 2022

Last updated

Feb 9, 2022By 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

Justus GichabaNPI 1174427579

Title

Owner

Phone

(678) 371-2657

Specialties & licenses 3

Addresses

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.

• Justus Gichaba

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Richmond, VA
  • NPI 1174427579
  Authorized official Same address or phone

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

{
    "created_epoch": "1644364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644364800000",
    "number": "1891449674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15320 WITS END DR",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221935889",
            "telephone_number": "678-371-2657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4343 DALE BLVD",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221932401",
            "telephone_number": "678-371-2657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE HEALTHCARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-09",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A",
        "authorized_official_last_name": "GICHABA",
        "authorized_official_first_name": "JUSTUS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-371-2657"
    },
    "taxonomies": [
        {
            "code": "364SH0200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Home Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "376G00000X",
            "taxonomy_group": "",
            "desc": "Nursing Home Administrator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Divine Health Support LLC
• Divine Medic Transport
• Divine Senior Home Care LLC
• Annalisa Divito
• Hengameh Djalal
• DMV Sports Medicine Institute

• Home Health Aide in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Home Health Aide in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; 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.