Provider Demographics
NPI:1467697037
Name:DEVINE HORIZON INDEPENDENT LIVING CENTER INC.
Entity Type:Organization
Organization Name:DEVINE HORIZON INDEPENDENT LIVING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR SALES & MARKETING
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:RIGGSBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-583-9058
Mailing Address - Street 1:129 CRYSTAL VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:TIMBERLAKE
Mailing Address - State:NC
Mailing Address - Zip Code:27583-9781
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:129 CRYSTAL VIEW DR
Practice Address - Street 2:
Practice Address - City:TIMBERLAKE
Practice Address - State:NC
Practice Address - Zip Code:27583-9781
Practice Address - Country:US
Practice Address - Phone:336-583-9058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care