Divine Care Services
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Brooklyn Park, MN. Organization (NPI-2).
NPI number1619784576
StatusActive
Last updated in NPPESDec 14, 2024
Details
- NPI
- 1619784576
- Entity type
- Organization (NPI-2)
- Legal business name
- Divine Care Services
- Organization subpart
- No
- Enumeration date
- Dec 14, 2024
- Certification date
- Dec 14, 2024
- Last updated
- Dec 14, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | – | – | Yes |
Other names
- Divine Care Services (Doing Business As)
- N/A (Doing Business As)
Practice location
6001 70th Ave NBrooklyn Park, MN 55429-1001
Phone 712-501-0363
Mailing address
1120 52nd Ave NeFridley, MN 55421-1876
Phone 710-210-0363
Authorized official
T-Max Blayon Barlue
Ceo
7125010363
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