Provider Demographics
NPI:1922338391
Name:DIVINE MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:DIVINE MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-273-6068
Mailing Address - Street 1:12012 WARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-2667
Mailing Address - Country:US
Mailing Address - Phone:225-273-6068
Mailing Address - Fax:225-273-6068
Practice Address - Street 1:12012 WARFIELD AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-2667
Practice Address - Country:US
Practice Address - Phone:225-273-6068
Practice Address - Fax:225-273-6068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)