Organization
DIVINE EMBRACE RESIDENTIAL HOMES
Active
Organization
DIVINE EMBRACE RESIDENTIAL HOMES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LA TANYA WILLIS FNP (OWNER)
(623) 887-0400
Entity
Organization
Contact information
Practice address
18444 N 25TH AVE STE 420, PHOENIX, AZ 85023-1268
(623) 887-0400
(623) 887-0402
Mailing address
12324 N 144TH DR, SURPRISE, AZ 85379-4477
(216) 798-3926
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/19/2022
Last updated
09/29/2023
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