Healthcare Provider Details

I. General information

NPI: 1346524378
Provider Name (Legal Business Name): DIVINE INTERVENTION REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 BEHRMAN PL STE 201
NEW ORLEANS LA
70114-8204
US

IV. Provider business mailing address

2700 VARNADO ST
MARRERO LA
70072-6620
US

V. Phone/Fax

Practice location:
  • Phone: 504-263-2800
  • Fax: 504-263-2821
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. SHERMONA JOSEPH-DUKES
Title or Position: CEO/OWNER
Credential: M.S.W.
Phone: 504-460-4896