Organization
DIVINE ASSURANCE BEHAVIORAL HEALTH RESIDENTAIL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCAS OLATUNDE (OWNER/ADMINISTRATOR)
(623) 932-5986
Entity
Organization
Contact information
Practice address
16040 W VOGEL AVE, GOODYEAR, AZ 85338-3571
(623) 932-5986
Mailing address
16040 W VOGEL AVE, GOODYEAR, AZ 85338-3571
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
BH5383
AZ
Other
Enumeration date
03/02/2018
Last updated
03/02/2018
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