institution
Divine House, Inc.
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Willmar, Minnesota
NPI 1720166259

Divine House, Inc. is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Willmar, MN. Divine House, Inc. practices in Willmar, MN. The NPI Number for Divine House, Inc. is 1720166259 and holds a License No. 344820700 (Minnesota).

The current practice location address for Divine House, Inc. is 328 5Th St Sw, Willmar, MN and can be reached out via phone at 320-231-2738 and via fax at 320-231-3666.

Location: 328 5Th St Sw, Willmar, MN, 56201-3200
institution
Provider Profile Details
NPI Number
1720166259
Provider Name
Divine House, Inc.
Credential
Provider Entity Type
Organization
Address
328 5Th St Sw, Willmar, MN, 56201-3200
Phone Number
320-231-2738
Fax Number
320-231-3666
Provider Enumeration Date
11/01/2006
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
202D2DI 01 MN BCBS ID
030701087 01 MN PRIME WEST
344820700 05 MN
754316600 01 MN PCA NUMBER
institution
Provider Business Practice Location Address Details
Address
328 5Th St Sw
City
State
Zip
56201-3200
Phone Number
320-231-2738
Fax Number
320-231-3666
person
Provider Business Mailing Address Details
Address
328 5Th St Sw
City
State
Zip
56201-3200
Phone Number
320-231-2738
Fax Number
320-231-3666
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
License No.
344820700 (Minnesota)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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