Provider Demographics
NPI:1144788316
Name:DIVINE PURPOSE COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:DIVINE PURPOSE COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEJUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-805-1070
Mailing Address - Street 1:1340 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3701
Mailing Address - Country:US
Mailing Address - Phone:410-805-1070
Mailing Address - Fax:
Practice Address - Street 1:1330 SMITH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3878
Practice Address - Country:US
Practice Address - Phone:410-805-1070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health