Divine Legacy

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

DIVINE LEGACY

Practice address

3300 County Road 10 Ste 318
Brooklyn Center, MN 55429-3066

Phone

(763) 439-2588

NPI assigned

Mar 18, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lakesia Aycock

Title

Administration/MHP

Phone

(763) 439-2588

Specialties & licenses 4

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552867200000",
    "number": "1073072260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 COUNTY ROAD 10 STE 318",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554293066",
            "telephone_number": "763-439-2588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 COUNTY ROAD 10 STE 318",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554293066",
            "telephone_number": "763-439-2588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE LEGACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-18",
        "last_updated": "2019-03-18",
        "status": "A",
        "authorized_official_last_name": "AYCOCK",
        "authorized_official_first_name": "LAKESIA",
        "authorized_official_title_or_position": "ADMINISTRATION/MHP",
        "authorized_official_telephone_number": "763-439-2588"
    },
    "taxonomies": [
        {
            "code": "261QC1800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Corporate Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lache Dietz
• Sierra Dimmel
• Divine Hands Home Health Agency Inc
• Divine Healing Home Care, LLC
• Divine Home Care Services LLC
• Thao DO, DDS
• Dominion Healthcare Services LLC
• Emma Jo Donley
• Kalissa Margaret Dorr
• Raissa Dos Santos Silva Kocher

• Mental Health Clinic/Center (Including Community Mental Health Center) in Brooklyn Center, MN
• Providers in Brooklyn Center, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.