Nea Divine Intervention Inc

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

NEA DIVINE INTERVENTION INC

Practice address

2504 Fairfield Dr
Jonesboro, AR 72401-6474

Phone

(870) 206-4455

NPI assigned

Jun 25, 2022

Organization subpart

No

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

Authorized official

Name

Miss Alexandra Mazique-Gilbert

Title

Administrative Assistant

Phone

(870) 316-0234

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Interoperability endpoints

• Direct secure messaging: shalinda.woolbright@afmc.org

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

{
    "created_epoch": "1656115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656115200000",
    "number": "1386376754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4213 TERI DAWN CV",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724057839",
            "telephone_number": "870-206-4455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2504 FAIRFIELD DR",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724016474",
            "telephone_number": "870-206-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEA DIVINE INTERVENTION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-25",
        "last_updated": "2022-06-25",
        "certification_date": "2022-06-25",
        "status": "A",
        "authorized_official_last_name": "MAZIQUE-GILBERT",
        "authorized_official_first_name": "ALEXANDRA",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "870-316-0234",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01031991",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Shalinda.Woolbright@afmc.org",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4213 Teri Dawn Cv",
            "city": "Jonesboro",
            "state": "AR",
            "country_code": "US",
            "postal_code": "724057839",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Substance Abuse Rehabilitation Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.