Provider Demographics
NPI:1598537458
Name:DIVINE RECOVERY SOLUTIONS LLC
Entity Type:Organization
Organization Name:DIVINE RECOVERY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CASANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-430-1912
Mailing Address - Street 1:607 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-2208
Mailing Address - Country:US
Mailing Address - Phone:434-430-1912
Mailing Address - Fax:
Practice Address - Street 1:101 BUFORD RD STE 203A
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5292
Practice Address - Country:US
Practice Address - Phone:434-430-1912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)