Provider Demographics
NPI:1659852820
Name:DIVINITY CARE CENTER
Entity Type:Organization
Organization Name:DIVINITY CARE CENTER
Other - Org Name:FLORENCE N BENNETT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:N
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-303-1325
Mailing Address - Street 1:PO BOX 300079
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77230-0079
Mailing Address - Country:US
Mailing Address - Phone:713-303-1325
Mailing Address - Fax:281-407-7744
Practice Address - Street 1:6111 WILCREST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-1447
Practice Address - Country:US
Practice Address - Phone:713-303-1325
Practice Address - Fax:281-407-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities