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NPI Code Detail

MEDICARE: DIVINE INTERVENTION REHABILITATION, LLC

MEDICARE: DIVINE INTERVENTION REHABILITATION, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1346524378
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIVINE INTERVENTION REHABILITATION, LLC
Provider Business Mailing Address
First Line : 2700 VARNADO ST
Second Line :
City : MARRERO
State : LA
Zip : 70072-6620
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3221 BEHRMAN PL STE 201
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70114-8204
Country : US
Telephone Number : 504-263-2800
Fax Number : 504-263-2821
Authorized Official
Title or Position : CEO/OWNER
Name : MRS. SHERMONA JOSEPH-DUKES
Credential : M.S.W.
Telephone Number : 504-460-4896
Provider Enumeration Date : 10/10/2011
Last Update Date : 06/12/2023

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