Provider Demographics
NPI:1578202834
Name:DIVINECARE AND RECOVERY LLC
Entity Type:Organization
Organization Name:DIVINECARE AND RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS-CAUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-617-9977
Mailing Address - Street 1:11899 ALGONQUIN DR UNIT 9
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6440
Mailing Address - Country:US
Mailing Address - Phone:832-617-9977
Mailing Address - Fax:
Practice Address - Street 1:11899 ALGONQUIN DR UNIT 9
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6440
Practice Address - Country:US
Practice Address - Phone:832-617-9977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities