Provider Demographics
NPI:1477025955
Name:DIVINE LOVE RESIDENTIAL HOMES, LLC
Entity Type:Organization
Organization Name:DIVINE LOVE RESIDENTIAL HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-986-4822
Mailing Address - Street 1:340 N SAM HOUSTON PKWY E STE A160I
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3305
Mailing Address - Country:US
Mailing Address - Phone:469-986-4822
Mailing Address - Fax:469-200-8339
Practice Address - Street 1:340 N SAM HOUSTON PKWY E STE A160I
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3305
Practice Address - Country:US
Practice Address - Phone:469-986-4822
Practice Address - Fax:469-200-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities