Provider Demographics
NPI:1760862841
Name:DIVERSE HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:DIVERSE HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MWANIKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-677-1676
Mailing Address - Street 1:1734 LAKEVIEW AVE
Mailing Address - Street 2:174
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-6325
Mailing Address - Country:US
Mailing Address - Phone:978-677-1676
Mailing Address - Fax:
Practice Address - Street 1:1734 LAKEVIEW AVE
Practice Address - Street 2:174
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-6325
Practice Address - Country:US
Practice Address - Phone:978-677-1676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health