Provider Demographics
NPI:1952705469
Name:DIVINE GENESIS LLC
Entity Type:Organization
Organization Name:DIVINE GENESIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DOULA
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:CLD, HCHD
Authorized Official - Phone:720-675-8343
Mailing Address - Street 1:10164 RIVERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10164 RIVERSTONE DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9164
Practice Address - Country:US
Practice Address - Phone:720-675-8343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty