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General NPI Number Information
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NPI Number | 1578043501
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Entity Type | Organization
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Legal Business Name | GRACE DIVINE HOME CARE, LLC
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 01/14/2019
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Provider Practice Location Address
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Address Line | 54 UNION ST FL 4
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City | ATTLEBORO
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State | MA
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Zip | 02703-2911
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Country | US
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Telephone | 508-455-0166
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Fax |
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Provider Business Mailing Address
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Address Line | 54 UNION ST FL 4
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City | ATTLEBORO
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State | MA
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Zip | 02703-2911
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Country | US
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Telephone | 508-455-0166
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Fax | 888-736-0651
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHERLEY LEFEVRE
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Credential | RN
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Telephone | 617-637-2066
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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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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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