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General NPI Number Information
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NPI Number | 1528665056
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Entity Type | Organization
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Legal Business Name | DIVINE HOUSE II INC.
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 1508 15TH ST SW
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City | WILLMAR
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State | MN
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Zip | 56201-3968
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Country | US
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Telephone | 320-231-2738
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Fax | 320-441-2106
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Provider Business Mailing Address
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Address Line | 328 5TH ST SW STE 5
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City | WILLMAR
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State | MN
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Zip | 56201-3585
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Country | US
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Telephone | 320-231-2738
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Fax | 320-441-2106
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DEBRA J SHRIVER
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Credential |
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Telephone | 320-231-2738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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