Provider Demographics
NPI:1740537489
Name:DIVINE DESTINY ADULT CARE INC.
Entity type:Organization
Organization Name:DIVINE DESTINY ADULT CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-934-7144
Mailing Address - Street 1:612 POWELL ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-3118
Mailing Address - Country:US
Mailing Address - Phone:919-934-7144
Mailing Address - Fax:877-778-8178
Practice Address - Street 1:612 POWELL ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3118
Practice Address - Country:US
Practice Address - Phone:919-934-7144
Practice Address - Fax:877-778-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251S00000XAgenciesCommunity/Behavioral Health