Organization
DIVINE CASE MANAGEMENT SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SELINA YVETTE ELLIS (OWNER)
(770) 679-4861
Entity
Organization
Contact information
Practice address
1237 SALEM GATE WAY SE, CONYERS, GA 30013-1637
(770) 679-4861
(888) 273-6606
Mailing address
PO BOX 81314, CONYERS, GA 30013-9314
(770) 679-4861
(888) 273-6606
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
GA
251B00000X
Case Management Agency
Primary
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251T00000X
PACE Provider Organization
—
—
Other
Enumeration date
06/12/2017
Last updated
06/12/2017
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