Provider Demographics
NPI:1659129088
Name:DIVINE YOUTH GUIDANCE LLC
Entity type:Organization
Organization Name:DIVINE YOUTH GUIDANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-717-4999
Mailing Address - Street 1:3700 FREDERICKSBURG RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-3266
Mailing Address - Country:US
Mailing Address - Phone:210-717-4999
Mailing Address - Fax:
Practice Address - Street 1:3700 FREDERICKSBURG RD STE 108
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-3266
Practice Address - Country:US
Practice Address - Phone:210-717-4999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)