Organization
DIVINE SUPPORTIVE HOMES INC
Active
Organization
DIVINE SUPPORTIVE HOMES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY C IKEJIAKU (MANAGER)
(919) 791-9032
Entity
Organization
Contact information
Practice address
3905 MARSH CREEK RD, RALEIGH, NC 27604-4108
(191) 791-9032
(919) 791-9032
Mailing address
549 IRINA DR, ROLESVILLE, NC 27571-9338
(919) 791-9032
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-092-539
NC
Other
Enumeration date
08/21/2017
Last updated
08/21/2017
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