10D2121231 CLIA NUMBER - DIVINITY HOME HEALTHCARE LLC

Laboratory Demographics

CLIA Number: 10D2121231

Facility Name: DIVINITY HOME HEALTHCARE LLC

Facility Address:
1734 KINGSLEY AVE STE 3
ORANGE PARK, FL
ZIP 32073
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Facility Phone Number: 904 900-8073

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1093168924

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name	Field Value
CLIA Number	10D2121231
LAB Type	Home Health Agency
Facility Name	DIVINITY HOME HEALTHCARE LLC
Street	1734 KINGSLEY AVE STE 3
City	ORANGE PARK
State	FL
ZIP	32073
Phone	904 900-8073
CertificateType	4
CertificateEffectiveDate	11/1/2022
CertificateExpirationDate	10/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024