Provider Demographics
NPI:1346524378
Name:DIVINE INTERVENTION REHABILITATION, LLC
Entity Type:Organization
Organization Name:DIVINE INTERVENTION REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH-DUKES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:504-460-4896
Mailing Address - Street 1:2700 VARNADO ST
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-6620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3221 BEHRMAN PL STE 201
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-8204
Practice Address - Country:US
Practice Address - Phone:504-263-2800
Practice Address - Fax:504-263-2821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health