Provider Demographics
NPI:1336369644
Name:DIVINE VISION DEVELOPMENT CENTERS INC
Entity type:Organization
Organization Name:DIVINE VISION DEVELOPMENT CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:859-806-1563
Mailing Address - Street 1:1313 N LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505
Mailing Address - Country:US
Mailing Address - Phone:859-806-1563
Mailing Address - Fax:
Practice Address - Street 1:1313 N LIMESTONE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-3243
Practice Address - Country:US
Practice Address - Phone:859-806-1563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYBD9026217320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities