Divinity Community Living, Inc.

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

DIVINITY COMMUNITY LIVING, INC.

Practice address

405 Briarwood Dr Ste 101B
Jackson, MS 39206-3029

Phone

(769) 572-7111

Fax

(769) 572-7327

NPI assigned

Jun 11, 2019

Organization subpart

No

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

Authorized official

Name

Susan Y Williams

Title

Ceo

Phone

(601) 462-4513

Specialties & licenses 2

Addresses

Other names 2

• Divinity Community Living, LLC Doing business as
• DCL Other name

Locations

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

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731628800000",
    "number": "1295394377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 BRIARWOOD DR STE 101B",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392063029",
            "telephone_number": "769-572-7111",
            "fax_number": "769-572-7327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 BRIARWOOD DR STE 101B",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392063029",
            "telephone_number": "769-572-7111",
            "fax_number": "769-572-7327"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "529 S Broadway St Ste 2",
            "address_purpose": "LOCATION",
            "city": "McComb",
            "state": "MS",
            "postal_code": "396485168",
            "country_code": "US",
            "telephone_number": "769-572-7111",
            "fax_number": "769-572-7327",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DIVINITY COMMUNITY LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-11",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-462-4513"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Divinity Community Living, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DCL",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "DCL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• In Home Supportive Care Agency in Jackson, MS
• Providers in Jackson, MS by specialty
• In Home Supportive Care Agency in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; 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.