Provider Demographics
NPI:1073130936
Name:R & R DIVINE LIVING, LLC
Entity Type:Organization
Organization Name:R & R DIVINE LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-414-0899
Mailing Address - Street 1:324 DAKOTA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-5339
Mailing Address - Country:US
Mailing Address - Phone:682-414-0899
Mailing Address - Fax:682-243-4223
Practice Address - Street 1:324 DAKOTA RIDGE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-5339
Practice Address - Country:US
Practice Address - Phone:682-414-0899
Practice Address - Fax:682-243-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities