Organization
DIVINE INTERVENTION RECOVERY CENTER, LLC
Active
Parent organization
DIVINE INTERVENTION RECOVERY CENTER LLC
Other names
Divine Intervention Recovery Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIVINE INTERVENTION RECOVERY CENTER LLC
Authorized official
FAYETTA BARRON LISW-S (DIRECTOR OF CLINICAL SERVICES)
(937) 797-1926
Entity
Organization
Contact information
Practice address
7373 DAYTON SPRINGFIELD RD, ENON, OH 45323-1462
(937) 862-0008
Mailing address
7373 DAYTON SPRINGFIELD RD, ENON, OH 45323-1462
(937) 862-0008
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
10/11/2022
Last updated
10/11/2022
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