Healthcare Provider Details

I. General information

NPI: 1861488686
Provider Name (Legal Business Name): SONS OF DIVINE PROVIDENCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ORIENT AVE
EAST BOSTON MA
02128-1006
US

IV. Provider business mailing address

111 ORIENT AVE
EAST BOSTON MA
02128-1006
US

V. Phone/Fax

Practice location:
  • Phone: 617-569-2100
  • Fax: 617-561-1138
Mailing address:
  • Phone: 617-569-2100
  • Fax: 617-561-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. STAN SAWICKI
Title or Position: ADMINISTRATOR
Credential:
Phone: 617-569-2100