NPIMap

Organization Active NPI

Divine Assurance Behavioral Health Residentail Care LLC

  • Substance Abuse Rehabilitation Facility
  • Goodyear, AZ
National Provider Identifier
1356843544
Registry record updated Mar 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
BH5383 Issued in AZ
Legal business name
DIVINE ASSURANCE BEHAVIORAL HEALTH RESIDENTAIL CARE LLC
Practice address
16040 W Vogel Ave
Goodyear, AZ 85338-3571
Phone
(623) 932-5986
NPI assigned
Mar 2, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2018

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

Authorized official

Name
Lucas Olatunde
Title
Owner/Administrator
Phone
(623) 932-5986

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X BH5383 AZ Primary

Addresses

Primary practice location

16040 W Vogel Ave
Goodyear, AZ 85338-3571

Mailing address

16040 W Vogel Ave
Goodyear, AZ 85338-3571

National Provider Directory

National Provider Directory
Tax ID family
Divine Assurance Behavioral Health Residentail Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1519948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519948800000",
    "number": "1356843544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16040 W VOGEL AVE",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853383571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16040 W VOGEL AVE",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853383571",
            "telephone_number": "623-932-5986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE ASSURANCE BEHAVIORAL HEALTH RESIDENTAIL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-02",
        "last_updated": "2018-03-02",
        "status": "A",
        "authorized_official_last_name": "OLATUNDE",
        "authorized_official_first_name": "LUCAS",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "623-932-5986"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AZ",
            "license": "BH5383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2018; 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.