Healthcare Provider Details

I. General information

NPI: 1053043901
Provider Name (Legal Business Name): SOTHER DIVINE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 PARK ST STE 208630
STOUGHTON MA
02072-3659
US

IV. Provider business mailing address

630 PARK ST STE 208
STOUGHTON MA
02072-3659
US

V. Phone/Fax

Practice location:
  • Phone: 781-414-0320
  • Fax:
Mailing address:
  • Phone: 781-414-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MISS JORANE JOSEPH
Title or Position: OWNER
Credential:
Phone: 781-414-0320