Provider Demographics
NPI:1477843464
Name:DYVONNE LLC
Entity Type:Organization
Organization Name:DYVONNE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:HARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-348-6786
Mailing Address - Street 1:P.O. BOX 2652
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30298-2652
Mailing Address - Country:US
Mailing Address - Phone:404-348-6786
Mailing Address - Fax:
Practice Address - Street 1:790 NORTH AVENUE
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-1430
Practice Address - Country:US
Practice Address - Phone:404-348-6786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)