Organization
DIVINE HEALTH SUPPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUGUSTINE SAFO (OWNER)
(571) 331-8483
Entity
Organization
Contact information
Practice address
2050 HANSON LN, WOODBRIDGE, VA 22191-4545
(571) 331-8483
(703) 551-0012
Mailing address
2050 HANSON LN, WOODBRIDGE, VA 22191-4545
(571) 331-8483
(703) 551-0012
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/02/2015
Last updated
01/02/2015
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