# DIVINITY'S RESIDENTIAL SERVICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497524250
- **Authorized official:** TAMMI R NELSON (OWNER)
- **Authorized official phone:** (330) 639-8258

## Contact information

- **Practice address:** 2814 VIENNA VIEW CT SW, CANTON, OH 44706-5629
- **Practice address phone:** (330) 639-8258
- **Mailing address:** 2814 VIENNA VIEW CT SW, CANTON, OH 44706-5629
- **Mailing address phone:** (330) 639-8258

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 12/21/2023
- **Last updated:** 12/21/2023