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General NPI Number Information
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NPI Number | 1134942311
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Entity Type | Organization
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Legal Business Name | J&K DIVINE CARE INC
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 56 PAWTUCKET BLVD
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City | TYNGSBORO
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State | MA
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Zip | 01879-1592
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Country | US
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Telephone | 781-658-0041
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Fax |
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Provider Business Mailing Address
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Address Line | 56 PAWTUCKET BLVD
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City | TYNGSBORO
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State | MA
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Zip | 01879-1592
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Country | US
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Telephone | 781-658-0041
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | RONALD KIMBUGWE
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Credential | LPN
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Telephone | 781-658-0041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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