Provider Demographics
NPI:1053063792
Name:DIVINE CARE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:DIVINE CARE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LACHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-759-9325
Mailing Address - Street 1:N19W24400 RIVERWOOD DR STE 350
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1182
Mailing Address - Country:US
Mailing Address - Phone:262-222-2806
Mailing Address - Fax:
Practice Address - Street 1:N34W23199 CIRCLE RIDGE RD APT 110
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5776
Practice Address - Country:US
Practice Address - Phone:414-759-9325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)