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General NPI Number Information
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NPI Number | 1780470757
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Entity Type | Organization
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Legal Business Name | DIVINE CORE LLC
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 116 SUMMIT TER APT 73
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2275
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Country | US
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Telephone | 469-685-4754
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Fax | 469-685-4754
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Provider Business Mailing Address
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Address Line | 116 SUMMIT TER APT 73
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2275
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Country | US
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Telephone | 469-685-4754
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Fax | 469-685-4754
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Authorized Official
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Title or Position | OWNER
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Name | MAGGY GATOYA
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Credential |
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Telephone | 469-685-4754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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