Healthcare Provider Details

I. General information

NPI: 1679478663
Provider Name (Legal Business Name): DIVINE RECOVERY HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E 18TH ST
ANTIOCH CA
94509-2835
US

IV. Provider business mailing address

801 E 18TH ST
ANTIOCH CA
94509-2835
US

V. Phone/Fax

Practice location:
  • Phone: 925-291-7494
  • Fax: 925-226-2424
Mailing address:
  • Phone: 925-291-7494
  • Fax: 925-226-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DORCE VENORD
Title or Position: PRESIDENT/CEO
Credential:
Phone: 407-286-8465