NPIMap

Organization Active NPI

Divine Case Management Services, LLC

  • Case Management Agency
  • Conyers, GA
National Provider Identifier
1992234082
Registry record updated Jun 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
DIVINE CASE MANAGEMENT SERVICES, LLC
Practice address
1237 Salem Gate Way SE
Conyers, GA 30013-1637
Phone
(770) 679-4861
Fax
(888) 273-6606
NPI assigned
Jun 12, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2017

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

Authorized official

Name
Mrs. Selina Yvette EllisNPI 1326343765
Title
Owner
Phone
(770) 679-4861

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X GA
Case Management Agency 251B00000X Primary
Public Health or Welfare Agency 251K00000X
Community/Behavioral Health Agency 251S00000X
PACE Provider Organization 251T00000X

Addresses

Primary practice location

1237 Salem Gate Way SE
Conyers, GA 30013-1637

Mailing address

PO Box 81314
Conyers, GA 30013-9314
Phone (770) 679-4861

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1497225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497225600000",
    "number": "1992234082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 81314",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300139314",
            "telephone_number": "770-679-4861",
            "fax_number": "888-273-6606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1237 SALEM GATE WAY SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300131637",
            "telephone_number": "770-679-4861",
            "fax_number": "888-273-6606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE CASE MANAGEMENT SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-12",
        "last_updated": "2017-06-12",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "SELINA",
        "authorized_official_middle_name": "YVETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-679-4861",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2017; 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.