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General NPI Number Information
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NPI Number | 1447699608
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Entity Type | Organization
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Legal Business Name | DEVINE TRINITY PERSONAL CARE HOME, INC.
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 29 OAK ST
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City | HINESVILLE
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State | GA
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Zip | 31313-3923
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Country | US
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Telephone | 912-271-2230
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Fax | 866-481-8163
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Provider Business Mailing Address
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Address Line | 29 OAK ST
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City | HINESVILLE
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State | GA
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Zip | 31313-3923
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Country | US
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Telephone | 912-271-2230
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Fax | 866-481-8163
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ROBIN TOWNSEND
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Credential |
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Telephone | 912-271-2230
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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 | 089-01-037-1
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License Number State | GA
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