# A DIVINE LIFESTYLE

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

## Provider details

- **NPI number:** 1821841784
- **Authorized official:** TAMIA ANITA HASKINS (OWNER)
- **Authorized official phone:** (984) 514-5259

## Contact information

- **Practice address:** 5530 TABBS CREEK CHURCH RD, OXFORD, NC 27565-5906
- **Practice address phone:** (984) 514-5259
- **Mailing address:** 5530 TABBS CREEK CHURCH RD, OXFORD, NC 27565-5906
- **Mailing address phone:** (984) 514-5259

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 04/10/2024
- **Last updated:** 04/10/2024