Provider Demographics
NPI:1912649716
Name:DIVINE INTERVENTION RECOVERY LLC
Entity type:Organization
Organization Name:DIVINE INTERVENTION RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SACHSE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:682-300-8075
Mailing Address - Street 1:305 NE LOOP 820 STE 103
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7211
Mailing Address - Country:US
Mailing Address - Phone:682-300-8075
Mailing Address - Fax:
Practice Address - Street 1:305 NE LOOP 820 STE 103
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-7211
Practice Address - Country:US
Practice Address - Phone:682-300-8075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility