DIVINE LEGACY (NPI# 1073072260) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073072260 |
| Entity Type | Organization |
| Organization Name | DIVINE LEGACY |
| Practice Address |
3300 County Road 10 Ste 318 Brooklyn Center MN 55429-3066 |
| Practice Telephone | 7634392588 |
| Mailing Telephone | 7634392588 |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2019-03-18 |
| Authorized Official Name | LAKESIA AYCOCK (ADMINISTRATION/MHP) |
| Authorized Official Telephone | 7634392588 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QC1800X |
Clinic/Center Specialization: Corporate Health |
Ambulatory Health Care Facilities | ||
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities | ||
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities | ||
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Divine Legacy Counseling and Consultation PLLC | 13926 Hull Street Rd Pmb 1078, Midlothian, Virginia 23112-2004 |
| Virginia Business Entities | Divine Legacy Enterprise LLC | 4201 31st St S Ste 617, Arlington, Virginia 22206 |
| Colorado Business Entities | Divine Legacy LLC | 38502 Lamborn Dr, Crawford, CO 81415 |
| New York State Corporations | DIVINE LEGACY MEDIA INC. | 1935 Mcgraw Ave, 1h, Bronx, Ny 10462 |
| Washington State Corporations | DIVINE LEGACY MUSIC GROUP, LLC | 21615 79th Ave W, Edmonds, WA 98026 |
| Street Address |
3300 COUNTY ROAD 10 STE 318 |
| City | BROOKLYN CENTER |
| State | MN |
| Zip Code | 55429-3066 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245852979 | Comfort Home Care | Home Health | 5950 Beard Ave N, Brooklyn Center, MN 55429 | 2020-05-15 |
| 1205300969 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 4835-4901 West Boradway Avenue, Crystal, MN 55429 | 2019-01-16 |
| 1780156208 | Crescent Cove | Pediatrics | 4201 58th Avd N., Brooklyn Center, MN 55429 | 2018-12-21 |
| 1184106254 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 4835-4901 W. Broadway Ave, Crystal, MN 55429 | 2018-09-05 |
| 1952889073 | Kelly Mcgregory Pediatrics LLC | Pediatrics | 6000 Bass Lake Rd Ste 102, Crystal, MN 55429 | 2018-07-31 |
| 1023510526 | Family Trust Home Health, LLC | Home Health | 5901 Brooklyn Blvd Ste 201, Brooklyn Center, MN 55429 | 2018-03-01 |
| 1962910588 | Yer Yang | Massage Therapist | 5531 Orchard Ave N, Crystal, MN 55429 | 2018-01-17 |
| 1790203347 | Akeya Bolden | Counselor | 3212 64th Ave N, Brooklyn Center, MN 55429 | 2017-09-05 |
| 1386169316 | Sadia Pauletta Kruah | Transportation Broker | 6756 Grimes Pl North, Brooklyn Center, MN 55429 | 2017-08-10 |
| 1982134904 | Chad Geyen | Marriage & Family Therapist | 3300 County Rd. 10, Brooklyn Center, MN 55429 | 2017-06-13 |
| Find all providers in zip 55429 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013139419 | Advanced Behavioral Health, Inc | Clinic/Center | 3300 County Road 10 Ste 500, Brooklyn Center, MN 55429 | 2007-05-03 |
| 1043363567 | Lds Family Services | Clinic/Center | 6120 Earle Brown Dr Ste 210, Brooklyn Center, MN 55430-4107 | 2007-01-19 |
| 1750300620 | The Counseling Clinic, Inc. | Clinic/Center | 6860 Shingle Creek Pkwy, Suite 116, Brooklyn Center, MN 55430-1411 | 2006-07-19 |
| 1356964332 | Village Support Therapy and Consulting LLC | Clinic/Center | 5424 Fremont Ave N, Brooklyn Center, MN 55430-3160 | 2020-05-25 |
| 1124593090 | Amal Healing Center | Clinic/Center | 3212 64th Ave N, Brooklyn Center, MN 55429-2237 | 2018-10-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821698671 | St. Cloud Tms LLC | Clinic/Center | 925 E Superior St Ste 106, Duluth, MN 55802-2253 | 2020-10-30 |
| 1740880764 | East Metro Trauma and Recovery LLC | Clinic/Center | 4116 Hoffman Rd, White Bear Lake, MN 55110-3708 | 2020-10-28 |
| 1851991160 | Gratia Counseling & Consulting, LLC | Clinic/Center | 2705 Bunker Lake Blvd Nw Ste 103, Andover, MN 55304-3786 | 2020-10-27 |
| 1508465147 | Piece of Mind Counseling Services, Pllc | Clinic/Center | 1122 Bemidji Ave N, Bemidji, MN 56601-2833 | 2020-10-24 |
| 1205433984 | Hopebridge Life Skills Center | Clinic/Center | 3617 E Lake St, Minneapolis, MN 55406-2148 | 2020-10-05 |
| 1275149007 | Clarity Counseling Services Pllc | Clinic/Center | 521 W Highway 2, Cohasset, MN 55721-2300 | 2020-09-17 |
| 1720693146 | Serene Therapy and Counseling Services LLC | Clinic/Center | 777 Berry St Apt 400b, Saint Paul, MN 55114-4006 | 2020-09-11 |
| 1427662592 | Threesixty, LLC | Clinic/Center | 4960 Miller Trunk Hwy # 600-b, Hermantown, MN 55811-1891 | 2020-09-04 |
| 1124639190 | Woodhaven Wellness | Clinic/Center | 3000 Carriage Dr, Hamel, MN 55340-9597 | 2020-08-13 |
| 1245840735 | Kalina Counseling Services | Clinic/Center | 120 7th St Unit 101, Two Harbors, MN 55616-1563 | 2020-08-09 |
| Find all providers with the same taxonomy | ||||
| City | BROOKLYN CENTER |
| Zip Code | 55429 |
Please comment or provide details below to improve the information on DIVINE LEGACY.
| 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.