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General NPI Number Information
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NPI Number | 1477025955
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Entity Type | Organization
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Legal Business Name | DIVINE LOVE RESIDENTIAL HOMES, LLC
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Dates
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Enumeration Date | 12/21/2018
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 340 N SAM HOUSTON PKWY E STE A160I
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City | HOUSTON
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State | TX
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Zip | 77060-3305
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Country | US
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Telephone | 469-986-4822
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Fax | 469-200-8339
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Provider Business Mailing Address
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Address Line | 340 N SAM HOUSTON PKWY E STE A160I
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City | HOUSTON
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State | TX
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Zip | 77060-3305
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Country | US
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Telephone | 469-986-4822
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Fax | 469-200-8339
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Authorized Official
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Title or Position | ADMINISTRATOR/CEO
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Name | TONI BOOTH
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Credential |
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Telephone | 469-986-4822
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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 |
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License Number State |
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