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General NPI Number Information
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NPI Number | 1629356308
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Entity Type | Organization
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Legal Business Name | DIVINE REFUGE CENTER, INC.
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Dates
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Enumeration Date | 07/28/2011
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Last Update Date | 07/28/2011
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Provider Practice Location Address
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Address Line | 3461 SALTASH LN
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City | TALLAHASSEE
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State | FL
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Zip | 32317-9009
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Country | US
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Telephone | 850-877-8570
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Fax | 850-656-1729
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Provider Business Mailing Address
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Address Line | 3461 SALTASH LN
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City | TALLAHASSEE
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State | FL
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Zip | 32317-9009
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Country | US
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Telephone | 850-877-8570
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Fax | 850-656-1729
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Authorized Official
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Title or Position | FOUNDER
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Name | MRS. KAREN DANNETTE BARNES
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Credential |
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Telephone | 850-877-8570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | FL
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