Provider Demographics
NPI:1740760644
Name:DIVINE CARE MEDICAL TRANSPORTATION, INC.
Entity Type:Organization
Organization Name:DIVINE CARE MEDICAL TRANSPORTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:N
Authorized Official - Last Name:NWUFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-246-5041
Mailing Address - Street 1:5155 W ROSECRANS AVE STE 212A
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6652
Mailing Address - Country:US
Mailing Address - Phone:800-246-5041
Mailing Address - Fax:310-491-7977
Practice Address - Street 1:5155 W ROSECRANS AVE STE 212A
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6652
Practice Address - Country:US
Practice Address - Phone:800-246-5041
Practice Address - Fax:310-491-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)