Provider Demographics
NPI:1891338141
Name:DIVINE HOLDINGS LLC
Entity Type:Organization
Organization Name:DIVINE HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-228-1084
Mailing Address - Street 1:821 WYLLIE AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4507
Mailing Address - Country:US
Mailing Address - Phone:434-228-1084
Mailing Address - Fax:434-793-9934
Practice Address - Street 1:1115 FRANKLIN TPKE STE 9
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-1362
Practice Address - Country:US
Practice Address - Phone:434-205-1869
Practice Address - Fax:434-793-9934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)