Healthcare Provider Details

I. General information

NPI: 1548192115
Provider Name (Legal Business Name): DIVINE JUSTICE PATHWAY HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33550 CEDAR CREEK LN
LAKE ELSINORE CA
92532-2537
US

IV. Provider business mailing address

2999 KENDALL DR STE 204
SAN BERNARDINO CA
92407-2436
US

V. Phone/Fax

Practice location:
  • Phone: 949-542-2744
  • Fax:
Mailing address:
  • Phone: 949-542-2744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DARNELL JOHNSON
Title or Position: OWNER / AUTHORIZED OFFICIAL
Credential:
Phone: 949-542-2744