Organization
DIVINE RESIDENTIAL LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAIME THORNTON (CEO)
(740) 527-1329
Entity
Organization
Contact information
Practice address
209 BOYD RD, MOUNT ORAB, OH 45154-8237
(937) 309-5125
Mailing address
4393 BLACKS RD SW, HEBRON, OH 43025-9774
(614) 592-6096
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0267919
—
OH
Enumeration date
11/23/2020
Last updated
11/23/2020
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