Provider Demographics
NPI:1205223146
Name:DIVINE AID SERVICES
Entity type:Organization
Organization Name:DIVINE AID SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIE ANNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CASSAGNOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-698-7753
Mailing Address - Street 1:340 FRANKLIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3491
Mailing Address - Country:US
Mailing Address - Phone:197-369-8773
Mailing Address - Fax:
Practice Address - Street 1:340 FRANKLIN ST FL 2
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3491
Practice Address - Country:US
Practice Address - Phone:197-369-8773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty