Provider Demographics
NPI:1437199619
Name:DIVINE VENTURES LLC
Entity Type:Organization
Organization Name:DIVINE VENTURES LLC
Other - Org Name:DIVINE MERCY HOME HEALTH SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:OMOWUNMI
Authorized Official - Last Name:SORINMADE
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA
Authorized Official - Phone:617-680-7614
Mailing Address - Street 1:5 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4026
Mailing Address - Country:US
Mailing Address - Phone:508-584-2855
Mailing Address - Fax:508-584-2866
Practice Address - Street 1:5 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4026
Practice Address - Country:US
Practice Address - Phone:508-584-2855
Practice Address - Fax:508-584-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5359950001Medicare ID - Type Unspecified