Organization
DIVINE KONCEPTS, INC
Active
Parent organization
DIVINE KONCEPTS
Other names
NLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIVINE KONCEPTS
Authorized official
T SHAWN GIBBS (DIRECTOR)
(704) 942-8410
Entity
Organization
Contact information
Practice address
451 FAITH DR SW, CONCORD, NC 28027-6929
(704) 942-8410
Mailing address
PO BOX 1310, CONCORD, NC 28026-1310
(704) 942-8410
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
013-033
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
049-143
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603599
—
NC
05
—
6603600
—
NC
Enumeration date
05/12/2008
Last updated
03/17/2018
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