Provider Demographics
NPI:1376857219
Name:D'VINE TRANSPORTATION, INC.
Entity Type:Organization
Organization Name:D'VINE TRANSPORTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:THURMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-517-4693
Mailing Address - Street 1:8851 S MOZART
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805
Mailing Address - Country:US
Mailing Address - Phone:773-517-4693
Mailing Address - Fax:
Practice Address - Street 1:8851 S MOZART AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-1141
Practice Address - Country:US
Practice Address - Phone:773-517-4693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0006416001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance