Organization
DIVINE SUPPORTS & HOMES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MAVIS NGUM TAH RN (CEO)
(240) 413-7682
Entity
Organization
Contact information
Practice address
13005 MAEPINE CT, FAIRFAX, VA 22033-3130
(240) 413-7682
Mailing address
9716 ANITA LN, LANHAM, MD 20706-3307
(240) 413-7682
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/14/2018
Last updated
09/14/2018
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