Provider Demographics
NPI:1760807002
Name:DIVINE TRANSFORMATIONS, LLC
Entity Type:Organization
Organization Name:DIVINE TRANSFORMATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALINE
Authorized Official - Middle Name:LENETTE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-298-9217
Mailing Address - Street 1:18151 SANTA ANN AVE
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4523
Mailing Address - Country:US
Mailing Address - Phone:313-215-3181
Mailing Address - Fax:313-731-7656
Practice Address - Street 1:1186 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1029
Practice Address - Country:US
Practice Address - Phone:313-215-3181
Practice Address - Fax:313-731-7656
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVINE TRANSFORMATIONS ADULT DAY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS630301996311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home