Organization
DIVINE LIGHT
Active
Parent organization
DIVINE LIGHT
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIVINE LIGHT
Authorized official
SAKINA PARKS (CEO)
(443) 552-1460
Entity
Organization
Contact information
Practice address
2211 MARYLAND AVE, BALTIMORE, MD 21218-5627
(443) 552-1460
Mailing address
2211 MARYLAND AVE, BALTIMORE, MD 21218-5627
(443) 552-1460
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
270019100
—
MD
Enumeration date
09/19/2019
Last updated
09/19/2019
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