Contract Details
Ancillary Care Services
Facility name
Divine Health Care
Provider ID
P000005058
NPI
1669674305
Tax ID
412223095
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
106 Southwest 27th Avenue Suite B
Miami, FL 33135
United States
County
Miami-Dade
Phone
3055413728 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Home Health
Map
Address