Divine Koncepts, Inc

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

013-033 Issued in NC

Legal business name

DIVINE KONCEPTS, INC

Practice address

451 Faith Dr SW
Concord, NC 28027-6929

Phone

(704) 942-8410

NPI assigned

May 12, 2008

Organization subpart

Yes

Parent organization

DIVINE KONCEPTSAs reported in NPPES

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

Addresses

Other identifiers 2

Other names 1

• NLLC Other name

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.

• Divine Koncepts, Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Stony Point, NC
  • NPI 1205093440
  NPD tax ID
• Divine Koncepts, Inc

  • Developmentally Disabled Services Day Training Agency
  • Rockingham, NC
  • NPI 1497857833
  NPD tax ID

Locations

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.

• Divine Koncepts, Inc

  • Developmentally Disabled Services Day Training Agency
  • Rockingham, NC
  • NPI 1497857833
  NPPES parent name

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

{
    "created_epoch": "1210550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1376710087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1310",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280261310",
            "telephone_number": "704-942-8410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 FAITH DR SW",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280276929",
            "telephone_number": "704-942-8410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "349 Copperfield Blvd NE",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280252408",
            "country_code": "US",
            "telephone_number": "704-942-8410",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "129 Plank Barn Ln",
            "address_purpose": "LOCATION",
            "city": "Stony Point",
            "state": "NC",
            "postal_code": "286789217",
            "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": "2008-05-12",
        "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": "049-143",
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "013-033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603600",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603599",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NLLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "NLLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jessica Grace Dilorenzo
• Gina Dimartino
• Uyen Dinh, MSW, LCSWA
• Brady Maurice Dion
• James Arthur Disney, M.D.
• Korinthia Dixon
• Michael John Dixon, CRNA
• Arthur Michael Dizon, M.D.
• Daisha Marie Dobbins, CRNA
• Lauren Sustar Dobner

• Mental Illness Community Based Residential Treatment Facility in Concord, NC
• Providers in Concord, NC by specialty
• Mental Illness Community Based Residential Treatment Facility in North Carolina

• 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.