Provider Demographics
NPI:1538310982
Name:DIVINITY ENTERPRISES LLC
Entity Type:Organization
Organization Name:DIVINITY ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NYAMARI
Authorized Official - Last Name:NYAOSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-341-6390
Mailing Address - Street 1:PO BOX 40365
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-8365
Mailing Address - Country:US
Mailing Address - Phone:651-341-6390
Mailing Address - Fax:
Practice Address - Street 1:8075 MAGNOLIA LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7177
Practice Address - Country:US
Practice Address - Phone:651-341-6390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNPENDING343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)