Healthcare Provider Details

I. General information

NPI: 1477497733
Provider Name (Legal Business Name): DIVINE HOPE HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 WILDWOOD PL NE
KEIZER OR
97303-2447
US

IV. Provider business mailing address

1720 WILDWOOD PL NE
KEIZER OR
97303-2447
US

V. Phone/Fax

Practice location:
  • Phone: 503-390-1105
  • Fax: 503-990-6285
Mailing address:
  • Phone: 503-390-1105
  • Fax: 503-990-6285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DIVINE KWIZERA
Title or Position: DIRECTOR
Credential:
Phone: 701-390-8728