Organization
DIVINE LIGHT RESIDENTIAL TREATMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SAKINA PARKS (CEO)
(267) 278-1079
Entity
Organization
Contact information
Practice address
1200 W BALTIMORE ST, BALTIMORE, MD 21223-2601
(667) 309-7643
Mailing address
1200 W BALTIMORE ST, BALTIMORE, MD 21223-2601
(667) 309-7643
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
12/08/2021
Last updated
12/08/2021
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