OrganizationActive
Divine Supports & Homes Inc.
NPI 1114400157 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Fairfax, VA
Provider details
- NPI number
- 1114400157
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Mavis Tah, Ceo(240) 413-7682
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
Profile Score
Established profile(67/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
13005 Maepine Ct
Fairfax, VA 22033-3130
Phone: (240) 413-7682
Street-level locationGet directions
Mailing address
9716 Anita Ln
Lanham, MD 20706-3307
Registry dates
- Enumerated
- 2018-09-14
- Last updated
- 2018-09-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.