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General NPI Number Information
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NPI Number | 1760287742
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Entity Type | Organization
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Legal Business Name | DIVINE RECOVERY LLC
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 1711 E BARNACLE AVE
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City | APACHE JUNCTION
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State | AZ
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Zip | 85119-3796
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Country | US
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Telephone | 602-402-9081
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Fax |
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Provider Business Mailing Address
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Address Line | 5810 E 14TH AVE
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City | APACHE JCT
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State | AZ
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Zip | 85119-9475
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Country | US
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Telephone | 619-324-3344
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOMINIC IULI
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Credential |
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Telephone | 619-492-8943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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