Provider Demographics
NPI:1639459969
Name:DRIVING MISS DAISY, INC.
Entity Type:Organization
Organization Name:DRIVING MISS DAISY, INC.
Other - Org Name:DRIVIMG MISS DAISY & HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:OMOSA
Authorized Official - Last Name:OMATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-253-4400
Mailing Address - Street 1:1710 DOUGLAS DR N
Mailing Address - Street 2:SUITE 260D
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4327
Mailing Address - Country:US
Mailing Address - Phone:763-253-4400
Mailing Address - Fax:763-253-4401
Practice Address - Street 1:1710 DOUGLAS DR N
Practice Address - Street 2:SUITE 260D
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4327
Practice Address - Country:US
Practice Address - Phone:763-253-4400
Practice Address - Fax:763-253-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN376396343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)