| Divine Intervention Recovery Center | |
|
7373 Dayton Springfield Rd Enon OH 45323-1462 | |
| (937) 862-0008 | |
| (937) 340-7004 |
| Full Name | Divine Intervention Recovery Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 7373 Dayton Springfield Rd, Enon, Ohio |
| Authorized Official Name and Position | Fayetta J Barron (OWNER) |
| Authorized Official Contact | 9372419230 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Intervention Recovery Center 7373 Dayton Springfield Rd Enon OH 45323-1462 Ph: (937) 862-0008 | Divine Intervention Recovery Center 7373 Dayton Springfield Rd Enon OH 45323-1462 Ph: (937) 862-0008 |
| NPI Number | 1912648528 |
|---|---|
| Provider Enumeration Date | 04/06/2022 |
| Last Update Date | 10/10/2022 |
| Certification Date | 09/26/2022 |
| Medicare PECOS PAC ID | 4789063694 |
|---|---|
| Medicare Enrollment ID | O20220623002443 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912648528 | NPI | - | NPPES |
| Provider Name | Jacob T Dean |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932172467 PECOS PAC ID: 6507751773 Enrollment ID: I20040217000535 |
| Provider Name | Jessica Warner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699429282 PECOS PAC ID: 4587042361 Enrollment ID: I20220607001815 |
| Provider Name | Tracy Bellville |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154845188 PECOS PAC ID: 6103205018 Enrollment ID: I20220607001981 |
| Provider Name | Faye Barron |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487196788 PECOS PAC ID: 4385023290 Enrollment ID: I20220624000174 |
| Provider Name | Katherine S Bendall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710426788 PECOS PAC ID: 8921487836 Enrollment ID: I20220624000425 |
| Provider Name | Ebrima Jatta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205134210 PECOS PAC ID: 7315326907 Enrollment ID: I20220628003074 |
Divine Intervention Recovery Center, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 7373 Dayton Springfield Rd, Enon, OH 45323 Phone: 937-862-0008 | |
Barron & Bendall Healing Center, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 340 E Main St, Enon, OH 45323 Phone: 937-797-1926 |