| NPI | 1073171021 |
|---|---|
| Other Name | DIVINITY RECOVERY |
| Entity Type | Organization |
| Authorized Contact | ANDREW FOSSUM COO 310-490-9741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2020-12-10 |