Provider Demographics
NPI:1962898270
Name:CARE DIVINE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:CARE DIVINE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:GUNDA DADZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-400-5643
Mailing Address - Street 1:245 RIVER ST
Mailing Address - Street 2:SUITE 128
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-3282
Mailing Address - Country:US
Mailing Address - Phone:978-400-5643
Mailing Address - Fax:978-627-3462
Practice Address - Street 1:245 RIVER ST
Practice Address - Street 2:SUITE 128
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-3282
Practice Address - Country:US
Practice Address - Phone:978-400-5643
Practice Address - Fax:978-627-3462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health