Provider Demographics
NPI:1861488686
Name:SONS OF DIVINE PROVIDENCE INC
Entity Type:Organization
Organization Name:SONS OF DIVINE PROVIDENCE INC
Other - Org Name:DON ORIONE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-569-2100
Mailing Address - Street 1:111 ORIENT AVE
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1006
Mailing Address - Country:US
Mailing Address - Phone:617-569-2100
Mailing Address - Fax:617-561-1138
Practice Address - Street 1:111 ORIENT AVE
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1006
Practice Address - Country:US
Practice Address - Phone:617-569-2100
Practice Address - Fax:617-561-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0999555Medicaid
MA0999555Medicaid
225413Medicare Oscar/Certification