Organization
DIVINE INDIVIDUALIZED SUPPORTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHRISTOPHER INMAN (CEO)
(856) 434-1856
Entity
Organization
Contact information
Practice address
703 ARONS CIR, SEWELL, NJ 08080-2534
(856) 434-1856
Mailing address
703 ARONS CIR, SEWELL, NJ 08080-2534
(856) 434-1856
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/15/2022
Last updated
09/15/2022
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