Provider Demographics
NPI:1023627049
Name:DERIVIERE HEALTH CARE STAFFING INC
Entity type:Organization
Organization Name:DERIVIERE HEALTH CARE STAFFING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WICHNITE
Authorized Official - Middle Name:
Authorized Official - Last Name:DERIVIERE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:617-223-7463
Mailing Address - Street 1:100 MERRIMACK ST STE 306
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1706
Mailing Address - Country:US
Mailing Address - Phone:617-223-7463
Mailing Address - Fax:888-811-5268
Practice Address - Street 1:100 MERRIMACK ST STE 306
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1706
Practice Address - Country:US
Practice Address - Phone:617-223-7463
Practice Address - Fax:888-811-5268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Multi-Specialty
No251F00000XAgenciesHome InfusionGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community Based
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110092881AMedicaid