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Organization
DIVINE HEART LLC
Active
Organization
DIVINE HEART LLC
Active
Other names
Divine Heart Behavioral Center
Organization subpart
No
Provider details
NPI number
Authorized official
FORSTER OKOLI (CHIEF EXECUTIVE OFFICER)
(520) 208-1970
Entity
Organization
Contact information
Practice address
1650 W SOUTHERN AVE STE 3, PHOENIX, AZ 85041-4627
(520) 208-1970
Mailing address
21903 S 187TH WAY, QUEEN CREEK, AZ 85142-6463
(652) 020-8197
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
Other
Enumeration date
01/01/2022
Last updated
03/14/2023
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