Organization
DIVINITY'S RESIDENTIAL SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMI R NELSON (OWNER)
(330) 639-8258
Entity
Organization
Contact information
Practice address
2814 VIENNA VIEW CT SW, CANTON, OH 44706-5629
(330) 639-8258
Mailing address
2814 VIENNA VIEW CT SW, CANTON, OH 44706-5629
(330) 639-8258
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
12/21/2023
Last updated
12/21/2023
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