Divine Residential Care Agency, LLC
NPI #1457775744 in Winona, Mississippi
Provider Information
- NPI Number
- 1457775744
- Entity Type
- Organization
- Organization Name
- Divine Residential Care Agency, LLC
- Primary Specialty
- Assisted Living Facility
- Enumeration Date
- Feb 7, 2014
- Last Updated
- Feb 7, 2014
Practice Location
- Address
- 506 SPEEDWAY AVE
- City
- Winona
- State
- Mississippi
- ZIP Code
- 38967-1816
- Phone
- (901) 281-2747
Authorized Official
- Name
- DAPHAINE MOORE BLAKES
- Title
- CEO
- Phone
- (901) 281-2747
Specialties & Taxonomy Codes
| Specialty |
|---|
| Assisted Living Facility |
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