Provider Demographics
NPI:1578043501
Name:GRACE DIVINE HOME CARE, LLC
Entity Type:Organization
Organization Name:GRACE DIVINE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFEVRE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:617-637-2066
Mailing Address - Street 1:54 UNION ST FL 4
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2911
Mailing Address - Country:US
Mailing Address - Phone:508-455-0166
Mailing Address - Fax:888-736-0651
Practice Address - Street 1:54 UNION ST FL 4
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2911
Practice Address - Country:US
Practice Address - Phone:508-455-0166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health