Provider Demographics
NPI:1568746659
Name:A-DIVINE RESIDENTIAL SOLUTIONS
Entity Type:Organization
Organization Name:A-DIVINE RESIDENTIAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:FLUELLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-315-8542
Mailing Address - Street 1:505 WOODWAY LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-1535
Mailing Address - Country:US
Mailing Address - Phone:903-315-8542
Mailing Address - Fax:
Practice Address - Street 1:505 WOODWAY LN
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-1535
Practice Address - Country:US
Practice Address - Phone:903-315-8542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness