Provider Demographics
NPI:1154915684
Name:D.I.V.I.N.E. INSTITUTE, INC.
Entity type:Organization
Organization Name:D.I.V.I.N.E. INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARETTA-RIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-447-5120
Mailing Address - Street 1:838 STELLAR PL
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-5446
Mailing Address - Country:US
Mailing Address - Phone:651-447-5120
Mailing Address - Fax:651-409-9530
Practice Address - Street 1:729 PENN AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-3625
Practice Address - Country:US
Practice Address - Phone:612-459-7011
Practice Address - Fax:651-409-9530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency