Divine Legacy

LBN: Divine Legacy
Divine Legacy is an health care organization with primary practice located at 3300 County Road 10 Ste 318 , Brooklyn Center MN 55429-3066. The organization recently has 4 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Corporate Health, Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center), Ambulatory Health Care Facilities / Adult Mental Health, Ambulatory Health Care Facilities / Adolescent and Children Mental Health. Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) is the primary health care specialty. Divine Legacy can be contacted via phone (763) 439-2588, or through Aycock, Lakesia via phone (763) 439-2588.

Contact Information

Primary practice address
3300 County Road 10 Ste 318 Brooklyn Center MN 55429-3066
Phone: (763) 439-2588
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Aycock, Lakesia
Phone: (763) 439-2588

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Corporate Health 261QC1800X
Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) 261QM0801X
Ambulatory Health Care Facilities / Adult Mental Health 261QM0850X
Ambulatory Health Care Facilities / Adolescent and Children Mental Health 261QM0855X

Profile Details

NPI number 1073072260
LBN Legal business name Divine Legacy
DBA Doing business as
Authorized official Aycock, Lakesia
Entity Organization
Organization subpart 1 No
Enumeration date Mar 18th, 2019
Last updated Mar 18th, 2019 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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