Divine Intervention Recovery Center, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

DIVINE INTERVENTION RECOVERY CENTER, LLC

Doing business as

Divine Intervention Recovery Center

Practice address

7373 Dayton Springfield Rd
Enon, OH 45323-1462

Phone

(937) 862-0008

NPI assigned

Oct 11, 2022

Last updated

Oct 11, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

DIVINE INTERVENTION RECOVERY CENTER LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fayetta Barron, LISW-S

Title

Director of Clinical Services

Phone

(937) 797-1926

Specialties & licenses 1

Addresses

Other names 1

• Divine Intervention Recovery Center Doing business as

Electronic endpoints 1

Tax ID family

Divine Intervention Recovery Center LLC2 organizations share this tax ID, including this one

Part of

Divine Intervention Recovery Center LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Divine Intervention Recovery Center, LLC

  dba Divine Intervention Recovery Center

  • Community/Behavioral Health Agency
  • Enon, OH
  • NPI 1629756176
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665446400000",
    "number": "1093430126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7373 DAYTON SPRINGFIELD RD",
            "city": "ENON",
            "state": "OH",
            "postal_code": "453231462",
            "telephone_number": "937-862-0008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7373 DAYTON SPRINGFIELD RD",
            "city": "ENON",
            "state": "OH",
            "postal_code": "453231462",
            "telephone_number": "937-862-0008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE INTERVENTION RECOVERY CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIVINE INTERVENTION RECOVERY CENTER LLC",
        "enumeration_date": "2022-10-11",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A",
        "authorized_official_last_name": "BARRON",
        "authorized_official_first_name": "FAYETTA",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL SERVICES",
        "authorized_official_telephone_number": "937-797-1926",
        "authorized_official_credential": "LISW-S"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "fayebarron@counselinsecure.com",
            "affiliation": "N",
            "endpointDescription": "encrypted email",
            "address_1": "7373 Dayton Springfield Rd",
            "city": "Enon",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453231462",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Divine Intervention Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bradley Bendall, CDCA
• Katherine Bendall
• Julia Marie Brugler, RN
• Tara Marie Cooper
• Jessica Deese, CDCA
• Divine Intervention Recovery Center, LLC (Divine Intervention Recovery Center)
• Divine Intervention Recovery Center, LLC (Divine Intervention Recovery Center)
• Brenda Lee Driscoll
• Ernst F. Fischer O.D., Inc.
• Ferguson Chiropractic Solutions

• Substance Use Disorder Rehabilitation Clinic/Center in Enon, OH
• Providers in Enon, OH by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.