| 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 |
|---|---|
| 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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