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Organization

DIVINE INTERVENTION TREATMENT FACILITY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TERIONE MONIQUE BROCK (OWNER/MANAGER)
(504) 415-9371
Entity
Organization

Contact information

Practice address
5665 6TH ST, VIOLET, LA 70092-3040
(504) 415-9371
Mailing address
PO BOX 259, VIOLET, LA 70092-0259
(504) 415-9371

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
Primary

Other

Enumeration date
02/02/2018
Last updated
02/02/2018
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