Organization · Type 2 NPI
Divine Residential Care Agency, LLC
Assisted Living Facility · Winona, MS
NPI number
1457775744
Active
Practice location
506 Speedway Ave
Winona, MS 38967-1816
Fax (662) 470-5771
Mailing address
7061 Foxhall Dr
Horn Lake, MS 38637-1269
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Assisted Living Facility Primary | 310400000X | None listed |
Assisted Living Facility: A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
About NPI 1457775744
Divine Residential Care Agency, LLC's National Provider Identifier is 1457775744, issued on Feb 7, 2014. The primary taxonomy on file is Assisted Living Facility (310400000X), and the practice location is in Winona, MS. The record was last updated on Feb 7, 2014.