Provider Demographics
NPI:1629795463
Name:THE DIVINE MIND HEALTHCARE EDUCATIONAL ADVANCED LEARNING SITE
Entity Type:Organization
Organization Name:THE DIVINE MIND HEALTHCARE EDUCATIONAL ADVANCED LEARNING SITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EDUCATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:954-857-8479
Mailing Address - Street 1:11 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6430
Mailing Address - Country:US
Mailing Address - Phone:954-603-1896
Mailing Address - Fax:954-678-2998
Practice Address - Street 1:11 PALM AVE
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-6430
Practice Address - Country:US
Practice Address - Phone:954-603-1896
Practice Address - Fax:954-678-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)