Divine Light

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

DIVINE LIGHT

Practice address

2211 Maryland Ave
Baltimore, MD 21218-5627

Phone

(443) 552-1460

NPI assigned

Sep 19, 2019

Last updated

Sep 19, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

DIVINE LIGHTAs reported in NPPES

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

Authorized official

Name

Sakina ParksNPI 1578232724

Title

Ceo

Phone

(443) 552-1460

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Divine Light

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sakina Parks

  • Substance Abuse Rehabilitation Facility
  • Baltimore, MD
  • NPI 1578232724
  NPD Authorized official

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

{
    "created_epoch": "1568851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568851200000",
    "number": "1427608611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 MARYLAND AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212185627",
            "telephone_number": "443-552-1460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 MARYLAND AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212185627",
            "telephone_number": "443-552-1460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE LIGHT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIVINE LIGHT",
        "enumeration_date": "2019-09-19",
        "last_updated": "2019-09-19",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "SAKINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "443-552-1460"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270019100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Divine Dental LLC (Brooklyn Park Dental Center)
• Divine Grace Health Services
• Divine Grace Health Services
• Divine Health Systems, Inc
• Divine Health Systems, Inc
• Divine Light Residential Treatment LLC
• Divine Light Residential Treatment LLC
• Divine Light Residential Treatment LLC
• Divine Living Limited Liability Company
• Divine Mercy, Inc. (Beacon of Hope Wellness Center)

• Community/Behavioral Health Agency in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Community/Behavioral Health Agency in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.