Provider Demographics
NPI:1609606417
Name:DIVINE AFC LLC
Entity type:Organization
Organization Name:DIVINE AFC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RATNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAGANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-368-4358
Mailing Address - Street 1:716 W BOYLSTON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-3074
Mailing Address - Country:US
Mailing Address - Phone:508-444-0955
Mailing Address - Fax:
Practice Address - Street 1:716 W BOYLSTON ST STE 2
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-3074
Practice Address - Country:US
Practice Address - Phone:508-444-0955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management