NPI 1114101342

Divine Residential Services, LLC

Organisation Mental Illness Community Based Residential Treatment Facility Richmond, VA

Practice location

Address: 6206 Manuel CT, Richmond, VA 23234-5894
Phone: (804) 918-1433
Mailing address: 12501 Chesdin Landing Dr, Chesterfield, VA 23838-3230

Authorised official

Name: Samara T Gracia
Title: Executive Director
Phone: (804) 306-1242

Registered specialties

Mental Illness Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320800000X Licence 89305001 (VA)

Other Community Based Residential Treatment Facility, Mental Illness providers in Virginia →

Registry record

NPI: 1114101342
Entity type: Organization
NPI issued: 24 Dec 2007
Record last updated: 24 Dec 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.