NPI 1619793445
Divine Residential Services, LLC
Practice location
- Address
- 2101 Proper St, Corinth, MS 38834-5247
- Phone
- (225) 810-0261
- Mailing address
- 18519 Loch Bend Ave, Greenwell Springs, LA 70739-4776
Authorised official
- Name
- Brandon Lavar Triggs
- Title
- Administrator
- Phone
- (225) 810-0261
Registered specialties
Psychiatric Residential Treatment Facility
Primary
Registry record
- NPI
- 1619793445
- Entity type
- Organization
- NPI issued
- 26 Nov 2024
- Record last updated
- 2 Jan 2025
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.