Provider Demographics
NPI:1245799634
Name:DIVINE TRANSPORTATION SERVICES LLC
Entity Type:Organization
Organization Name:DIVINE TRANSPORTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:RA'SEAN
Authorized Official - Middle Name:DEMOND
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-402-9204
Mailing Address - Street 1:7225 BRIDLE PATH
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-9575
Mailing Address - Country:US
Mailing Address - Phone:318-402-9204
Mailing Address - Fax:
Practice Address - Street 1:7225 BRIDLE PATH
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771
Practice Address - Country:US
Practice Address - Phone:318-402-9204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)