Organization
DIVINE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KWANE MITCHELL WATSON (OWNER)
(502) 523-2347
Entity
Organization
Contact information
Practice address
2500 W BROADWAY, LOUISVILLE, KY 40211-1081
(502) 523-2347
Mailing address
2500 W BROADWAY, LOUISVILLE, KY 40211-1081
(502) 523-2347
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/27/2013
Last updated
12/27/2013
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