Organization
DIVINE ASSURANCE BEHAVIORAL HEALTH RESIDENTAIL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCAS OLATUNDE (CEO)
(602) 628-6708
Entity
Organization
Contact information
Practice address
17496 W ELAINE DR, GOODYEAR, AZ 85338-1981
(602) 628-6708
Mailing address
17496 W ELAINE DR, GOODYEAR, AZ 85338-1981
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
02/24/2021
Last updated
02/24/2021
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