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1568702520
JEFFREY ALAN DIVINE
GRASS VALLEY, CA
NPI
1568702520
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
322D00000X Residential Treatment Facility, Emotionally Disturbed Children
Enumeration Date
2013-02-27
Last Update Date
2013-02-27
Business Address
-- JEFFREY ALAN DIVINE
714 W MAIN ST
GRASS VALLEY, CA 95945-6410
Phone number: 530-477-9800
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Mailing Address
-- JEFFREY ALAN DIVINE
714 W MAIN ST
GRASS VALLEY, CA 95945-6410
Phone number: 530-477-9800
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