Organization
A DIVINE MIRACLE ADULT DAY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPHINE B SCOTT BSN/RN (EXECUTIVE DIRECTOR/OWNER)
(615) 891-7412
Entity
Organization
Contact information
Practice address
331 GALLATIN PIKE S STE 1, MADISON, TN 37115-4052
(615) 830-2430
Mailing address
331 GALLATIN PIKE S STE 1, MADISON, TN 37115-4052
(615) 830-2430
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q014710
—
TN
Enumeration date
11/21/2018
Last updated
12/07/2018
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