Provider Demographics
NPI:1467642991
Name:DIVINE GUIDANCE INTEGRATIVE SERVICES, INC
Entity Type:Organization
Organization Name:DIVINE GUIDANCE INTEGRATIVE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-695-6040
Mailing Address - Street 1:2317 EXECUTIVE CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3762
Mailing Address - Country:US
Mailing Address - Phone:252-695-6040
Mailing Address - Fax:
Practice Address - Street 1:2317 EXECUTIVE CIR
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3762
Practice Address - Country:US
Practice Address - Phone:252-695-6040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301931BMedicaid