Organization
DIVINE RESIDENTIAL SERVICES, LLC.
Active
Organization
DIVINE RESIDENTIAL SERVICES, LLC.
Active
Other names
Divine Transformation
Organization subpart
No
Provider details
NPI number
Authorized official
SAMARA GRACIA (EXECUTIVE DIRECTOR)
(804) 306-1242
Entity
Organization
Contact information
Practice address
6206 MANUEL CT, RICHMOND, VA 23234-5894
(804) 918-1433
Mailing address
12501 CHESDIN LANDING DR, CHESTERFIELD, VA 23838-3230
(804) 306-1242
(804) 590-2304
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
89305001
VA
Other
Enumeration date
03/06/2007
Last updated
12/05/2007
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