Provider Demographics
NPI:1184100695
Name:DELIVERANCE TRANSPORTATION SERVICES
Entity type:Organization
Organization Name:DELIVERANCE TRANSPORTATION SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONOVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-531-0282
Mailing Address - Street 1:PO BOX 3721
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-0721
Mailing Address - Country:US
Mailing Address - Phone:443-531-0282
Mailing Address - Fax:
Practice Address - Street 1:2200 PARK AVE APT C1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-4997
Practice Address - Country:US
Practice Address - Phone:443-531-0282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DONOVAN COLVIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)