Organization
DIVINE KONCEPTS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA T CAPEL B.S./QP (PRESIDENT/CEO)
(910) 417-4950
Entity
Organization
Contact information
Practice address
1219 ROCKINGHAM RD, SUITE 12, ROCKINGHAM, NC 28379-4983
(910) 417-4950
(910) 417-4953
Mailing address
PO BOX 462, ELLERBE, NC 28338-0462
(910) 417-4950
(910) 417-4953
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
RES/CAP/CIS
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
MHL-077-044
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3418060
—
NC
05
—
7805610
—
NC
05
—
8300948
—
NC
Enumeration date
09/05/2006
Last updated
09/05/2007
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