| Divine Home Care Changes | |
|
106 Ethel Dr Vicksburg MS 39180-8905 | |
| (919) 339-1854 | |
| Not Available |
| Full Name | Divine Home Care Changes |
|---|---|
| Speciality | In Home Supportive Care |
| Location | 106 Ethel Dr, Vicksburg, Mississippi |
| Authorized Official Name and Position | Chasity Davis (CEO) |
| Authorized Official Contact | 9193391854 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Home Care Changes Po Box 821878 Vicksburg MS 39182-1878 Ph: () - | Divine Home Care Changes 106 Ethel Dr Vicksburg MS 39180-8905 Ph: (919) 339-1854 |
| NPI Number | 1174132476 |
|---|---|
| Provider Enumeration Date | 07/23/2020 |
| Last Update Date | 10/07/2022 |
| Certification Date | 10/07/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174132476 | NPI | - | NPPES |
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