Healthcare Provider Details

I. General information

NPI: 1790678175
Provider Name (Legal Business Name): DIVINE INTERVENTION ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BATTLEGROUND AVE
GREENSBORO NC
27408-8042
US

IV. Provider business mailing address

1400 BATTLEGROUND AVE
GREENSBORO NC
27408-8042
US

V. Phone/Fax

Practice location:
  • Phone: 336-988-8844
  • Fax: 336-285-5674
Mailing address:
  • Phone: 336-988-8844
  • Fax: 336-285-5674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEENA M MOYE LIVINGSTON
Title or Position: OWNER/PROGRAM DIRECTOR
Credential: MH/SUD/IDD QP
Phone: 336-988-8844