Provider Demographics
NPI:1043688617
Name:DIVINE TRANSPORTATION INC.
Entity Type:Organization
Organization Name:DIVINE TRANSPORTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-803-1043
Mailing Address - Street 1:N86W16351 APPLETON AVE
Mailing Address - Street 2:APT.28
Mailing Address - City:MENOMONEE FLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2977
Mailing Address - Country:US
Mailing Address - Phone:414-803-1043
Mailing Address - Fax:262-415-5609
Practice Address - Street 1:N86W16351 APPLETON AVE
Practice Address - Street 2:APT.28
Practice Address - City:MENOMONEE FLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2977
Practice Address - Country:US
Practice Address - Phone:414-803-1043
Practice Address - Fax:262-415-5609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-12
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0201086343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)