Organization
DIVINE CARE SERVICES
Active
Other names
N/A, Divine Care Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. T-MAX BLAYON BARLUE MD (CEO)
(712) 501-0363
Entity
Organization
Contact information
Practice address
6001 70TH AVE N, BROOKLYN PARK, MN 55429-1001
(712) 501-0363
Mailing address
1120 52ND AVE NE, FRIDLEY, MN 55421-1876
(710) 210-0363
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/14/2024
Last updated
12/14/2024
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