Healthcare Provider Details

I. General information

NPI: 1649766031
Provider Name (Legal Business Name): DIVINE ASSISTED LIVING FACILITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 E CITRUS ST
ALTAMONTE SPRINGS FL
32701-2614
US

IV. Provider business mailing address

533 E CITRUS ST
ALTAMONTE SPRINGS FL
32701-2614
US

V. Phone/Fax

Practice location:
  • Phone: 301-651-4037
  • Fax:
Mailing address:
  • Phone: 301-651-4037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: NADINE MCDANIEL
Title or Position: ADMINISTRATOR
Credential:
Phone: 301-651-4037