Healthcare Provider Details

I. General information

NPI: 1760287742
Provider Name (Legal Business Name): DIVINE RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 E BARNACLE AVE
APACHE JUNCTION AZ
85119-3796
US

IV. Provider business mailing address

5810 E 14TH AVE
APACHE JCT AZ
85119-9475
US

V. Phone/Fax

Practice location:
  • Phone: 602-402-9081
  • Fax:
Mailing address:
  • Phone: 619-324-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DOMINIC IULI
Title or Position: OWNER
Credential:
Phone: 619-492-8943