Provider Demographics
NPI:1609554989
Name:DIVINE TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:DIVINE TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARNOT
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNYANDAMUTSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-394-5989
Mailing Address - Street 1:3707 E SOUTHERN AVE STE 2079
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-6219
Mailing Address - Country:US
Mailing Address - Phone:602-394-5989
Mailing Address - Fax:
Practice Address - Street 1:3707 E SOUTHERN AVE STE 2079
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6219
Practice Address - Country:US
Practice Address - Phone:602-394-5989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:C&A HOMECARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty