Healthcare Provider Details

I. General information

NPI: 1679116156
Provider Name (Legal Business Name): DIVINE PURPOSE SERVICES LIMITED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 EBENEZER RD STE J4
ROCK HILL SC
29732-1079
US

IV. Provider business mailing address

100 LESLIE DR
SHELBY NC
28152-0757
US

V. Phone/Fax

Practice location:
  • Phone: 704-300-5544
  • Fax:
Mailing address:
  • Phone: 704-300-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRANDY USSERY
Title or Position: OWNER
Credential:
Phone: 704-300-5544