Divine Supports & Homes Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

DIVINE SUPPORTS & HOMES INC.

Practice address

13005 Maepine CT
Fairfax, VA 22033-3130

Phone

(240) 413-7682

NPI assigned

Sep 14, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Mavis Ngum Tah, RN

Title

Ceo

Phone

(240) 413-7682

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1536883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536883200000",
    "number": "1114400157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9716 ANITA LN",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207063307",
            "telephone_number": "240-413-7682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13005 MAEPINE CT",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220333130",
            "telephone_number": "240-413-7682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE SUPPORTS & HOMES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-14",
        "last_updated": "2018-09-14",
        "status": "A",
        "authorized_official_last_name": "TAH",
        "authorized_official_first_name": "MAVIS",
        "authorized_official_middle_name": "NGUM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "240-413-7682",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2018; 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.