Provider Demographics
NPI:1184373052
Name:DIVINE COMMUNITY ADVOCATES
Entity type:Organization
Organization Name:DIVINE COMMUNITY ADVOCATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDDREKA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:219-796-0556
Mailing Address - Street 1:6515 LIGHTHOUSE DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368
Mailing Address - Country:US
Mailing Address - Phone:870-816-7570
Mailing Address - Fax:
Practice Address - Street 1:6515 LIGHTHOUSE DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368
Practice Address - Country:US
Practice Address - Phone:870-816-7570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable