Divine House II Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

DIVINE HOUSE II INC.

Practice address

2974 192ND St
Dawson, MN 56232

Phone

(320) 769-4444

NPI assigned

Feb 7, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Todd Hillstrom

Title

Administrator

Phone

(320) 769-4444

Specialties & licenses 1

Addresses

Tax ID family

Divine House II Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Divine House II Inc.

  dba Willmar ICF-MR

  • Intellectual Disabilities Intermediate Care Facility
  • Willmar, MN
  • NPI 1528665056
  NPD tax ID

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770623217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2974 192ND ST",
            "address_2": "PO BOX 309",
            "city": "DAWSON",
            "state": "MN",
            "postal_code": "56232",
            "telephone_number": "320-769-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2974 192ND ST",
            "city": "DAWSON",
            "state": "MN",
            "postal_code": "56232",
            "telephone_number": "320-769-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE HOUSE II INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HILLSTROM",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "320-769-4444"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Utpal U Chakravorty, MD
• Jill Jocelyn Christie, C.F.N.P
• Erica Clark
• Dawson Drug PLLC
• Dawson Drug PLLC
• Krystle Marie Drietz, CNP, PMHNP
• Renae A Durfee, FNP-C
• Facing New Horizons, Inc.
• Larry Jay Grong, D.O.
• Thomas Walter Hansen, DDS

• Intellectual Disabilities Intermediate Care Facility in Dawson, MN
• Providers in Dawson, MN by specialty
• Intellectual Disabilities Intermediate Care Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.