Divergent Recovery Llc | |
15655 W Roosevelt St Ste 100 Goodyear AZ 85338-9311 | |
(480) 336-0507 | |
Not Available |
Full Name | Divergent Recovery Llc |
---|---|
Speciality | Community/behavioral Health |
Location | 15655 W Roosevelt St Ste 100, Goodyear, Arizona |
Authorized Official Name and Position | Garrett Deetz (OWNER) |
Authorized Official Contact | 4803360507 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Divergent Recovery Llc 8140 W Mission Ln Peoria AZ 85345-4829 Ph: (480) 336-0507 | Divergent Recovery Llc 15655 W Roosevelt St Ste 100 Goodyear AZ 85338-9311 Ph: (480) 336-0507 |
NPI Number | 1104554864 |
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Provider Enumeration Date | 08/10/2022 |
Last Update Date | 08/10/2022 |
Certification Date | 08/10/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104554864 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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