Provider Demographics
NPI:1053043901
Name:SOTHER DIVINE CARE LLC
Entity Type:Organization
Organization Name:SOTHER DIVINE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JORANE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-414-0320
Mailing Address - Street 1:630 PARK ST STE 208
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3659
Mailing Address - Country:US
Mailing Address - Phone:781-414-0320
Mailing Address - Fax:
Practice Address - Street 1:630 PARK ST STE 208630
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3659
Practice Address - Country:US
Practice Address - Phone:781-414-0320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health