Provider Demographics
NPI:1306039441
Name:DIVINE VISION DEVELOPMENTS
Entity Type:Organization
Organization Name:DIVINE VISION DEVELOPMENTS
Other - Org Name:DVD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:GIBSON
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:859-402-2292
Mailing Address - Street 1:2901 RICHMOND RD
Mailing Address - Street 2:SUITE 130-174
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1771
Mailing Address - Country:US
Mailing Address - Phone:859-402-2292
Mailing Address - Fax:
Practice Address - Street 1:2901 RICHMOND RD
Practice Address - Street 2:SUITE 130-174
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1771
Practice Address - Country:US
Practice Address - Phone:859-402-2292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities