Healthcare Provider Details

I. General information

NPI: 1316479280
Provider Name (Legal Business Name): DIVINE TREATMENT CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14462 ALLEGAN ST
WHITTIER CA
90604-1837
US

IV. Provider business mailing address

14462 ALLEGAN ST
WHITTIER CA
90604-1837
US

V. Phone/Fax

Practice location:
  • Phone: 714-589-9228
  • Fax:
Mailing address:
  • Phone: 714-589-9228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. EDGAR ANTONIO VILLA
Title or Position: PRESIDENT
Credential: LCSW
Phone: 714-589-9228