Divine Care Services

Primary specialty

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

Legal business name

DIVINE CARE SERVICES

Doing business as

Divine Care Services
N/a

Practice address

6001 70TH Ave N
Brooklyn Park, MN 55429-1001

Phone

(712) 501-0363

NPI assigned

Dec 14, 2024

Organization subpart

No

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

Authorized official

Name

Mr. T-Max Blayon Barlue, MD

Title

Ceo

Phone

(712) 501-0363

Specialties & licenses 1

Addresses

Other names 2

• Divine Care Services Doing business as
• N/A Doing business as

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

{
    "created_epoch": "1734134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734134400000",
    "number": "1619784576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 52ND AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554211876",
            "telephone_number": "710-210-0363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6001 70TH AVE N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554291001",
            "telephone_number": "712-501-0363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE CARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-14",
        "last_updated": "2024-12-14",
        "certification_date": "2024-12-14",
        "status": "A",
        "authorized_official_last_name": "BARLUE",
        "authorized_official_first_name": "T-MAX",
        "authorized_official_middle_name": "BLAYON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-501-0363",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "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": [
        {
            "organization_name": "Divine Care Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "N/A",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jennifer Vanoverbeke Ditlevson, PHARMD
• Kaitlyne Ashly Marie Dittberner, OTR/L
• Diversified Joy
• Divine Love Homecare Services, LLC
• Divine Mercy LLC.
• Divine Nurturing Alliance of Caring, Inc.
• Divine Transportation LLC
• Susan May Dodge, LICSW

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Brooklyn Park, MN
• Providers in Brooklyn Park, MN by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Minnesota

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