Provider Demographics
NPI:1629356308
Name:DIVINE REFUGE CENTER, INC.
Entity Type:Organization
Organization Name:DIVINE REFUGE CENTER, INC.
Other - Org Name:DIVINE REFUGE CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:DANNETTE
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-877-8570
Mailing Address - Street 1:3461 SALTASH LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-9009
Mailing Address - Country:US
Mailing Address - Phone:850-877-8570
Mailing Address - Fax:850-656-1729
Practice Address - Street 1:3461 SALTASH LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-9009
Practice Address - Country:US
Practice Address - Phone:850-877-8570
Practice Address - Fax:850-656-1729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization