MEDICARE: DIVINITY CARE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1659852820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINITY CARE CENTER

Provider Business Mailing Address
First Line	:	PO BOX 300079
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77230-0079
Country	:	US
Telephone Number	:	713-303-1325
Fax Number	:	281-407-7744

Provider Business Practice Location Address
First Line	:	6111 WILCREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-1447
Country	:	US
Telephone Number	:	713-303-1325
Fax Number	:	281-407-7744

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	FLORENCE N BENNETT
Credential	:
Telephone Number	:	713-303-1325

Provider Enumeration Date	:	08/27/2018
Last Update Date	:	10/02/2023

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