Provider Demographics
NPI:1992479521
Name:THE ROSE OF SHARON7 DIVINE INTERVENTION RECOVERY
Entity type:Organization
Organization Name:THE ROSE OF SHARON7 DIVINE INTERVENTION RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED ALCOHOL/DRUG TECHNICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BARGER
Authorized Official - Suffix:
Authorized Official - Credentials:RADT
Authorized Official - Phone:951-390-2267
Mailing Address - Street 1:23931 WARREN ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582
Mailing Address - Country:US
Mailing Address - Phone:951-390-2267
Mailing Address - Fax:
Practice Address - Street 1:23931 WARREN ROAD
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582
Practice Address - Country:US
Practice Address - Phone:951-390-2267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility