NPIMap

Organization Active NPI

Divine Light Residential Treatment LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Baltimore, MD
National Provider Identifier
1730890146
Registry record updated Dec 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
DIVINE LIGHT RESIDENTIAL TREATMENT LLC
Practice address
1200 W Baltimore St
Baltimore, MD 21223-2601
Phone
(667) 309-7643
Fax
(667) 210-2879
NPI assigned
Dec 6, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2022

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

Authorized official

Name
Sakina Dean
Title
C.E.O
Phone
(267) 278-1079

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

1200 W Baltimore St
Baltimore, MD 21223-2601

Mailing address

1200 W Baltimore St
Baltimore, MD 21223-2601
Phone (667) 309-7643

National Provider Directory

National Provider Directory
Tax ID family
Divine Light Residential Treatment LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1200 W Baltimore St
Baltimore, MD 21223
Phone (267) 278-1079

NPI Registry JSON

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

{
    "created_epoch": "1670284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670284800000",
    "number": "1730890146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W BALTIMORE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212232601",
            "telephone_number": "667-309-7643",
            "fax_number": "667-210-2879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W BALTIMORE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212232601",
            "telephone_number": "667-309-7643",
            "fax_number": "667-210-2879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE LIGHT RESIDENTIAL TREATMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-06",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A",
        "authorized_official_last_name": "DEAN",
        "authorized_official_first_name": "SAKINA",
        "authorized_official_title_or_position": "C.E.O",
        "authorized_official_telephone_number": "267-278-1079"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2022; 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.