Organization
DIVINE HOUSE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BELA SV AMIN PT (ADMINISTRATOR)
(757) 202-0825
Entity
Organization
Contact information
Practice address
3429 STIRRUP WAY, VIRGINIA BEACH, VA 23453-8546
(757) 202-0825
Mailing address
912 BEAUMEADE CT, VIRGINIA BEACH, VA 23462-4642
(757) 202-0825
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
1157
VA
Other
Enumeration date
04/27/2009
Last updated
04/27/2009
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