Provider Demographics
NPI:1750614111
Name:DIVINELY DIRECTED SERVICES
Entity type:Organization
Organization Name:DIVINELY DIRECTED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAWTHORNE
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMIN
Authorized Official - Phone:757-558-6914
Mailing Address - Street 1:961 CANAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-4766
Mailing Address - Country:US
Mailing Address - Phone:757-558-6914
Mailing Address - Fax:757-558-6915
Practice Address - Street 1:2909 ARCADIA AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-6055
Practice Address - Country:US
Practice Address - Phone:757-397-9058
Practice Address - Fax:757-558-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1075-14-001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities