NPIMap

Organization Active NPI

Divine Light Residential Treatment LLC

  • Substance Abuse Rehabilitation Facility
  • Baltimore, MD
National Provider Identifier
1962147082
Registry record updated May 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
DIVINE LIGHT RESIDENTIAL TREATMENT LLC
Practice address
1200 W Baltimore St
Baltimore, MD 21223-2601
Phone
(267) 278-1079
NPI assigned
May 3, 2022
Last updated
May 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2022

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

Authorized official

Name
Sakina Dean
Title
Chief Executive Officer
Phone
(267) 278-1079

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

1200 W Baltimore St
Baltimore, MD 21223-2601

Mailing address

1200 W Baltimore St
Baltimore, MD 21223-2601

Other identifiers 1

IdentifierTypeStateIssuer
577023800MedicaidMD

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL TALKEHR

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": "1651536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651536000000",
    "number": "1962147082",
    "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"
        },
        {
            "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": "267-278-1079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE LIGHT RESIDENTIAL TREATMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-03",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A",
        "authorized_official_last_name": "DEAN",
        "authorized_official_first_name": "SAKINA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "267-278-1079"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "577023800",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "TALKEHR",
            "affiliation": "N",
            "address_1": "1200 W Baltimore St",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212232601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 May 3, 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.