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General NPI Number Information
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NPI Number | 1003254053
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Entity Type | Organization
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Legal Business Name | DIVINE LIVING ALF INC
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Dates
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Enumeration Date | 06/12/2013
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Last Update Date | 06/12/2013
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Provider Practice Location Address
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Address Line | 471 NEPTUNE DR NE
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City | PALM BAY
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State | FL
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Zip | 32907-1508
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Country | US
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Telephone | 321-622-4615
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Fax |
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Provider Business Mailing Address
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Address Line | 4630 DECATUR CIR
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City | MELBOURNE
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State | FL
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Zip | 32934-7290
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Country | US
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Telephone | 321-622-4615
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. NADJI D WILLIAMS
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Credential |
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Telephone | 321-622-4615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 12360
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License Number State | FL
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