Divine Residential Services, LLC

NPI #1114101342 in Richmond, Virginia

Provider Information

NPI Number: 1114101342
Entity Type: Organization
Organization Name: Divine Residential Services, LLC
Primary Specialty: Community Based Residential Treatment Facility, Mental Illness
Enumeration Date: Dec 24, 2007
Last Updated: Dec 24, 2007

Practice Location

Address: 6206 MANUEL CT
City: Richmond
State: Virginia
ZIP Code: 23234-5894
Phone: (804) 918-1433

Authorized Official

Name: MRS. SAMARA T GRACIA, QMHP
Title: EXECUTIVE DIRECTOR
Phone: (804) 306-1242

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Mental Illness	320800000X	Primary

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