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General NPI Number Information
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NPI Number | 1912201732
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Entity Type | Organization
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Legal Business Name | DIVINE TRANSFORMATIONS, LLC
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Dates
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Enumeration Date | 01/09/2011
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Last Update Date | 01/09/2011
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Provider Practice Location Address
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Address Line | 18151 SANTA ANN AVE
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-4523
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Country | US
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Telephone | 248-569-3582
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Fax |
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Provider Business Mailing Address
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Address Line | 18151 SANTA ANN AVE
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-4523
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Country | US
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Telephone | 248-569-3582
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ROSALIINE WHITE
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Credential |
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Telephone | 248-298-9217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AS630301996
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License Number State | MI
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