NPIMap

Organization Active NPI

Divine Koncepts, Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Stony Point, NC
National Provider Identifier
1205093440
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
049-143 Issued in NC
Legal business name
DIVINE KONCEPTS, INC
Practice address
129 Plank Barn LN
Stony Point, NC 28678-9217
Phone
(704) 942-8410
NPI assigned
May 16, 2008
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
DIVINE KONCEPTSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
T Shawn Gibbs
Title
Director
Phone
(704) 942-8410

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 013-033 NC
Mental Illness Community Based Residential Treatment Facility 320800000X 049-143 NC Primary

Addresses

Primary practice location

129 Plank Barn LN
Stony Point, NC 28678-9217

Mailing address

451 Faith Dr SW
Concord, NC 28027-6929
Phone (704) 942-8410

Other practice location 1

451 Faith Dr SW
Concord, NC 28027-6929
Phone (704) 942-8410

Other identifiers 2

IdentifierTypeStateIssuer
6603599MedicaidNC
6603600MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Divine Koncepts Inc3 organizations share this tax ID, including this one
Part of
Divine Koncepts Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

451 Faith Dr SW
Concord, NC 28027
Phone (704) 771-0456

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1205093440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 FAITH DR SW",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280276929",
            "telephone_number": "704-942-8410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 PLANK BARN LN",
            "city": "STONY POINT",
            "state": "NC",
            "postal_code": "286789217",
            "telephone_number": "704-942-8410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "451 Faith Dr SW",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280276929",
            "country_code": "US",
            "telephone_number": "704-942-8410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DIVINE KONCEPTS, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIVINE KONCEPTS",
        "enumeration_date": "2008-05-16",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "GIBBS",
        "authorized_official_first_name": "T",
        "authorized_official_middle_name": "SHAWN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "704-942-8410"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "013-033",
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "049-143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603599",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603600",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Point, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.