Organization
DIVINE KONCEPTS, INC
Active
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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