Provider Demographics
NPI:1619308715
Name:DIVINE DHARMA, LLC
Entity Type:Organization
Organization Name:DIVINE DHARMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-507-8283
Mailing Address - Street 1:5115 STATE ROUTE 45
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:OH
Mailing Address - Zip Code:44085-9403
Mailing Address - Country:US
Mailing Address - Phone:614-507-8283
Mailing Address - Fax:
Practice Address - Street 1:5115 STATE ROUTE 45
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:OH
Practice Address - Zip Code:44085-9403
Practice Address - Country:US
Practice Address - Phone:614-507-8283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-28
Last Update Date:2013-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.019797225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty