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General NPI Number Information
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NPI Number | 1447980768
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Entity Type | Organization
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Legal Business Name | DIVINITY FACILITY LLC
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 35523 AVONDALE ST
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City | WESTLAND
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State | MI
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Zip | 48186-4160
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Country | US
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Telephone | 313-805-4727
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Fax | 248-924-2032
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Provider Business Mailing Address
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Address Line | PO BOX 479
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-0479
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Country | US
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Telephone | 313-805-4727
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Fax | 248-924-2032
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SONYA SMITH
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Credential |
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Telephone | 313-805-4727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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