Organization
DEVINE PROVIDENCE HOME LLC
Active
Other names
DEVINE PROVIDENCE HOME LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA TUEDJO FEGAING (DIRECTOR/MANAGER)
(682) 375-3968
Entity
Organization
Contact information
Practice address
3025 BLUE JAY LN, MIDLOTHIAN, TX 76065-8705
(682) 375-3968
Mailing address
3025 BLUE JAY LN, MIDLOTHIAN, TX 76065-8705
(682) 375-3968
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/29/2021
Last updated
12/06/2021
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