Organization
DIVINE RESIDENTIAL CARE AGENCY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAPHAINE MOORE BLAKES (CEO)
(901) 281-2747
Entity
Organization
Contact information
Practice address
506 SPEEDWAY AVE, WINONA, MS 38967-1816
(901) 281-2747
(662) 470-5771
Mailing address
7061 FOXHALL DR, HORN LAKE, MS 38637-1269
(901) 281-2747
(662) 470-5771
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
02/07/2014
Last updated
02/07/2014
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