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General NPI Number Information
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NPI Number | 1174675623
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Entity Type | Organization
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Legal Business Name | A GREATER DIVINE PLACE INC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 366 BREMEN GARDEN DR
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City | LEXINGTON
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State | NC
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Zip | 27295-6044
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Country | US
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Telephone | 336-484-8022
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Fax |
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Provider Business Mailing Address
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Address Line | 100 HAMILTON RD
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City | LEXINGTON
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State | NC
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Zip | 27295-1831
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Country | US
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Telephone | 336-239-4312
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Fax |
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Authorized Official
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Title or Position | OWNER CEO
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Name | JOHN DARIN GRIFFIN
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Credential |
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Telephone | 336-239-4312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 029098
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License Number State | NC
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