Organization
NEA DIVINE INTERVENTION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ALEXANDRA MAZIQUE-GILBERT (ADMINISTRATIVE ASSISTANT)
(870) 316-0234
Entity
Organization
Contact information
Practice address
2504 FAIRFIELD DR, JONESBORO, AR 72401-6474
(870) 206-4455
Mailing address
4213 TERI DAWN CV, JONESBORO, AR 72405-7839
(870) 206-4455
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01031991
—
AR
Enumeration date
06/25/2022
Last updated
06/25/2022
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