Provider Demographics
NPI:1144115924
Name:DIVINE HOME CARE SERVICES
Entity type:Organization
Organization Name:DIVINE HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WANKETHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-385-3874
Mailing Address - Street 1:121 FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475
Mailing Address - Country:US
Mailing Address - Phone:833-385-3874
Mailing Address - Fax:
Practice Address - Street 1:121 FRONT STREET
Practice Address - Street 2:
Practice Address - City:PURVIS
Practice Address - State:MS
Practice Address - Zip Code:39475
Practice Address - Country:US
Practice Address - Phone:833-385-3874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNSON DIAGNOSTIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care