Provider Demographics
NPI:1790071058
Name:DIVINITY GROUP ENTERPRISES INC
Entity Type:Organization
Organization Name:DIVINITY GROUP ENTERPRISES INC
Other - Org Name:N/A
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:678-939-6664
Mailing Address - Street 1:3207 SUNNYFORD LANE
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GEORGIA
Mailing Address - Zip Code:30038
Mailing Address - Country:UM
Mailing Address - Phone:678-939-6664
Mailing Address - Fax:786-272-0641
Practice Address - Street 1:3207 SUNNYFORD LN
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2260
Practice Address - Country:US
Practice Address - Phone:678-939-6664
Practice Address - Fax:786-272-0641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health