Provider Demographics
NPI:1023827854
Name:DIVINE TRANSITIONS LLC
Entity type:Organization
Organization Name:DIVINE TRANSITIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-760-3500
Mailing Address - Street 1:131 NAHM ST STE 9
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4362
Mailing Address - Country:US
Mailing Address - Phone:270-625-5005
Mailing Address - Fax:270-713-0638
Practice Address - Street 1:131 NAHM ST STE 9
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4362
Practice Address - Country:US
Practice Address - Phone:270-625-5005
Practice Address - Fax:270-713-0638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100866450Medicaid