Organization
DIVINE GROUP HOME LLC
Active
Organization
DIVINE GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIVINE KUSI (ADMIN)
(480) 939-0573
Entity
Organization
Contact information
Practice address
40352 W MOLLY LN # A, MARICOPA, AZ 85138-5158
(480) 939-0573
Mailing address
40352 W MOLLY LN, MARICOPA, AZ 85138-5158
(480) 939-0573
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/18/2021
Last updated
10/21/2021
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