Provider Demographics
NPI:1205548849
Name:DIVINE HEALTH EMERGENCY MEDICAL SERVICES
Entity type:Organization
Organization Name:DIVINE HEALTH EMERGENCY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIONTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-580-2273
Mailing Address - Street 1:1 GATEWAY CTR STE 2600
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-5323
Mailing Address - Country:US
Mailing Address - Phone:833-580-2273
Mailing Address - Fax:973-988-1241
Practice Address - Street 1:1 GATEWAY CTR STE 2600
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-5323
Practice Address - Country:US
Practice Address - Phone:833-580-2273
Practice Address - Fax:973-988-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport