Provider Demographics
NPI:1073254827
Name:DESTINY TO WELLNESS TRANSPORTATION BR, LLC.
Entity Type:Organization
Organization Name:DESTINY TO WELLNESS TRANSPORTATION BR, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUINCY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-518-1308
Mailing Address - Street 1:5345 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-5242
Mailing Address - Country:US
Mailing Address - Phone:347-277-4320
Mailing Address - Fax:
Practice Address - Street 1:5345 LINDEN ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-5242
Practice Address - Country:US
Practice Address - Phone:347-277-4320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)