Organization
DIVINE RESIDENTIAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON LAVAR TRIGGS MBA (ADMINISTRATOR)
(225) 810-0261
Entity
Organization
Contact information
Practice address
2101 PROPER ST, CORINTH, MS 38834-5247
(225) 810-0261
Mailing address
18519 LOCH BEND AVE, GREENWELL SPRINGS, LA 70739-4776
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/26/2024
Last updated
01/02/2025
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