Organization
DIVINE HERITAGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CLARICE THOMAS ROBERTS RN (PRESIDENT)
(813) 317-7991
Entity
Organization
Contact information
Practice address
11911 PINE FOREST DR, NEW PORT RICHEY, FL 34654-1462
(813) 317-7991
Mailing address
8575 MONTRAVAIL CIR, #737, TEMPLE TERRACE, FL 33637-3035
(646) 673-0044
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
09/22/2016
Last updated
09/22/2016
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