Provider Demographics
NPI:1720149495
Name:DESTINY (MEDICAL) TRANSPORTATION INC.
Entity Type:Organization
Organization Name:DESTINY (MEDICAL) TRANSPORTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KAMORU
Authorized Official - Middle Name:S
Authorized Official - Last Name:ADIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-883-4302
Mailing Address - Street 1:3953 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-7312
Mailing Address - Country:US
Mailing Address - Phone:216-883-4302
Mailing Address - Fax:216-883-2657
Practice Address - Street 1:3953 E 71ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-7312
Practice Address - Country:US
Practice Address - Phone:216-883-4302
Practice Address - Fax:216-883-2657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2500770343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)