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General NPI Number Information
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NPI Number | 1043428394
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Entity Type | Organization
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Legal Business Name | DIVINE BLESSINGS
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 904 JEFFREY ST
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4215
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Country | US
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Telephone | 386-252-9578
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Fax |
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Provider Business Mailing Address
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Address Line | 904 JEFFREY ST
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4215
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Country | US
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Telephone | 386-252-9578
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS GWENDOLYN CUFFEE
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Credential | MEDICAID PROVIDER
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Telephone | 386-252-9578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 06-12-077
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License Number State | FL
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