Provider Demographics
NPI:1134942311
Name:J&K DIVINE CARE INC
Entity type:Organization
Organization Name:J&K DIVINE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBUGWE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:781-658-0041
Mailing Address - Street 1:56 PAWTUCKET BLVD
Mailing Address - Street 2:
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-1592
Mailing Address - Country:US
Mailing Address - Phone:781-658-0041
Mailing Address - Fax:
Practice Address - Street 1:56 PAWTUCKET BLVD
Practice Address - Street 2:
Practice Address - City:TYNGSBORO
Practice Address - State:MA
Practice Address - Zip Code:01879-1592
Practice Address - Country:US
Practice Address - Phone:781-658-0041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health