Divine at Hillsboro St Inc.

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

DIVINE AT HILLSBORO ST INC.

Practice address

502 N Hillsboro St
Youngsville, NC 27596-7779

Phone

(919) 880-4619

NPI assigned

Jan 8, 2018

Organization subpart

No

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

Authorized official

Name

Chris O Isijola, ADMINISTRATOR

Title

Owner/President

Phone

(919) 880-4619

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1515369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515369600000",
    "number": "1871000141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 N HILLSBORO ST",
            "city": "YOUNGSVILLE",
            "state": "NC",
            "postal_code": "275967779",
            "telephone_number": "919-880-4619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 N HILLSBORO ST",
            "city": "YOUNGSVILLE",
            "state": "NC",
            "postal_code": "275967779",
            "telephone_number": "919-880-4619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE AT HILLSBORO ST INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-08",
        "last_updated": "2018-01-08",
        "status": "A",
        "authorized_official_last_name": "ISIJOLA",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "919-880-4619",
        "authorized_official_credential": "ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Youngsville, NC
• Providers in Youngsville, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.