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NPI Code Detail

MEDICARE: SONS OF DIVINE PROVIDENCE INC

MEDICARE: SONS OF DIVINE PROVIDENCE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861488686
Entity Type Code : Organization
Provider Name (Legal Business Name) : SONS OF DIVINE PROVIDENCE INC
Provider Business Mailing Address
First Line : 111 ORIENT AVE
Second Line :
City : EAST BOSTON
State : MA
Zip : 02128-1006
Country : US
Telephone Number : 617-569-2100
Fax Number : 617-561-1138
Provider Business Practice Location Address
First Line : 111 ORIENT AVE
Second Line :
City : EAST BOSTON
State : MA
Zip : 02128-1006
Country : US
Telephone Number : 617-569-2100
Fax Number : 617-561-1138
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. STAN SAWICKI
Credential :
Telephone Number : 617-569-2100
Provider Enumeration Date : 09/27/2005
Last Update Date : 01/24/2008

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Directions to “SONS OF DIVINE PROVIDENCE INC ” Practice Location

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