Healthcare Provider Details

I. General information

NPI: 1023627049
Provider Name (Legal Business Name): DERIVIERE HEALTH CARE STAFFING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERRIMACK ST STE 306
LOWELL MA
01852-1706
US

IV. Provider business mailing address

100 MERRIMACK ST STE 306
LOWELL MA
01852-1706
US

V. Phone/Fax

Practice location:
  • Phone: 617-223-7463
  • Fax: 888-811-5268
Mailing address:
  • Phone: 617-223-7463
  • Fax: 888-811-5268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: WICHNITE DERIVIERE
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 617-223-7463