Healthcare Provider Details

I. General information

NPI: 1811677651
Provider Name (Legal Business Name): DIVINE HEALTH GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MORGAN RD
HOLBROOK MA
02343-1632
US

IV. Provider business mailing address

30 MORGAN RD
HOLBROOK MA
02343-1632
US

V. Phone/Fax

Practice location:
  • Phone: 339-208-7255
  • Fax:
Mailing address:
  • Phone: 857-247-7529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: CHINELO OKORO
Title or Position: PRESIDENT
Credential:
Phone: 857-247-7529