Divine Residential Services, LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

89305001 Issued in VA

Legal business name

DIVINE RESIDENTIAL SERVICES, LLC

Practice address

6206 Manuel CT
Richmond, VA 23234-5894

Phone

(804) 918-1433

NPI assigned

Dec 24, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Samara T Gracia, QMHP

Title

Executive Director

Phone

(804) 306-1242

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1198454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198454400000",
    "number": "1114101342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12501 CHESDIN LANDING DR",
            "city": "CHESTERFIELD",
            "state": "VA",
            "postal_code": "238383230",
            "telephone_number": "804-306-1242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6206 MANUEL CT",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232345894",
            "telephone_number": "804-918-1433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE RESIDENTIAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-24",
        "last_updated": "2007-12-24",
        "status": "A",
        "authorized_official_last_name": "GRACIA",
        "authorized_official_first_name": "SAMARA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "804-306-1242",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "QMHP"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "VA",
            "license": "89305001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diversity Training & Support Center
• Divine Kings & Queens
• Divine Mind Therapeutics LLC
• Divine Minds Youth Services
• Divine Pathways Support Services LLC
• Divine Residential Services, LLC.
• Thomas James Dix, DDS
• Neel Dixit, MD
• Alia Renee Dixon, FNP-BC
• Brian Karl Dixon

• Mental Illness Community Based Residential Treatment Facility in Richmond, VA
• Providers in Richmond, VA by specialty
• Mental Illness Community Based Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2007; 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.