Healthcare Provider Details

I. General information

NPI: 1750199857
Provider Name (Legal Business Name): DIVINE COMMUNITY AFC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WEST MAIN ST BUILDING C SUITE 1 & 2
NORTHBOROUGH MA
01532
US

IV. Provider business mailing address

300 WEST MAIN ST BUILDING C SUITE 1 & 2
NORTHBOROUGH MA
01532
US

V. Phone/Fax

Practice location:
  • Phone: 508-466-8050
  • Fax: 617-934-7265
Mailing address:
  • Phone: 508-466-8050
  • Fax: 617-934-7265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SULEIMAN KAMARA
Title or Position: CEO
Credential:
Phone: 508-375-8333