DIVINE RESIDENTIAL CARE AGENCY, LLC (NPI# 1457775744) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457775744 |
| Entity Type | Organization |
| Organization Name | DIVINE RESIDENTIAL CARE AGENCY, LLC |
| Practice Address |
506 Speedway Ave Winona MS 38967-1816 |
| Mailing Address |
7061 Foxhall Dr Horn Lake MS 38637-1269 |
| Practice Telephone | 9012812747 |
| Practice Fax Number | 6624705771 |
| Mailing Telephone | 9012812747 |
| Mailing Fax Number | 6624705771 |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2014-02-07 |
| Authorized Official Name | DAPHAINE MOORE BLAKES (CEO) |
| Authorized Official Telephone | 9012812747 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Street Address |
506 SPEEDWAY AVE |
| City | WINONA |
| State | MS |
| Zip Code | 38967-1816 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538630835 | Zachary Leon Selby | Occupational Therapist | 1521, 409 Tyler Holmes Dr, Winona, MS 38967 | 2018-12-12 |
| 1275937211 | Tonette Holmes | Community Health Worker | 720 Simpson Dr, Winona, MS 38967 | 2014-10-20 |
| 1124274196 | Family Health Care Clinic, Inc. | Clinic/Center | 123 N Front St, Winona, MS 38967 | 2008-08-11 |
| 1588782577 | Jacquelyn D Lucas | Optometrist | 639 Middleton Rd, Winona, MS 38967 | 2007-03-27 |
| 1154447514 | Robert Manning | Dentist | 1612 Hwy 51 N, Winona, MS 38967 | 2007-03-21 |
| 1518034347 | Hammonds Pharmacy Inc | Pharmacy | 405c N Applegate, Winona, MS 38967 | 2006-11-29 |
| 1336256858 | Kilmichael Medical Suppliers Inc | Durable Medical Equipment & Medical Supplies | 107 N Front Street, Winona, MS 38967 | 2006-08-23 |
| 1285649855 | Tyler Holmes Memorial Hospital | Family Medicine | 700 Woodland Drive, Winona, MS 38967 | 2006-07-30 |
| 1437676962 | Roger Beardain | Pharmacist | 603 Middleton Rd, Winona, MS 38967 | 2017-08-25 |
| 1235323643 | Kilmichael Medical Supplies | Pharmacist | 107 N Front Street, Winona, MS 38967 | 2007-08-29 |
| Find all providers in zip 38967 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356691729 | Winona Senior Living, LLC | Assisted Living Facility | 765 Menard Rd, Winona, MN 55987-3669 | 2012-09-13 |
| 1699831156 | Brookdale Senior Living Communities, Inc. | Assisted Living Facility | 835 E Belleview St, Winona, MN 55987-4502 | 2006-12-29 |
| 1134334543 | Winona Senior Services, Inc. | Assisted Living Facility | 175 E Wabasha St, Winona, MN 55987-3492 | 2007-05-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215558747 | Waymaker Enterprises, LLC | Assisted Living Facility | 204 Bradfield Rd, Madison, MS 39110-7035 | 2020-05-06 |
| 1417508110 | Maxine Delores Harris | Assisted Living Facility | 104 Martin Luther King Blvd, Arcola, MS 38722 | 2019-09-24 |
| 1548819733 | Snh Omiss Tenant LLC | Assisted Living Facility | 1488 Belk Blvd, Oxford, MS 38655-5356 | 2019-09-10 |
| 1457900649 | Snh Omiss Tenant LLC | Assisted Living Facility | 108 Clarington Dr, Southaven, MS 38671-5640 | 2019-09-10 |
| 1972152619 | The Claiborne At Adelaide | Assisted Living Facility | 74 Claiborne Way, Starkville, MS 39759-8544 | 2019-09-05 |
| 1992369102 | James Wilson | Assisted Living Facility | 15986 W Main St, Louisville, MS 39339-2636 | 2019-04-24 |
| 1023519766 | The Blake At Oxford | Assisted Living Facility | 110 Ed Perry Blvd, Oxford, MS 38655-3452 | 2018-02-27 |
| 1194224873 | Barnes Crossing Retirement Community LLC | Assisted Living Facility | 1090 County Road 811, Saltillo, MS 38866-7304 | 2018-02-07 |
| 1649782202 | Garden Hill Assisted Living | Assisted Living Facility | 2082 Yorkville Rd E, Columbus, MS 39702-9406 | 2017-11-03 |
| 1891228581 | Magnolia Gardens Assisted Living | Assisted Living Facility | 303 East Ivy, Ellisville, MS 39437 | 2017-04-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.