Provider Demographics
NPI:1801616693
Name:DIVINE AGAPE SHUTTLE RIDES
Entity type:Organization
Organization Name:DIVINE AGAPE SHUTTLE RIDES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAE BEVERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOMINGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-397-0757
Mailing Address - Street 1:300 E ESPLANADE DR STE 1670
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0247
Mailing Address - Country:US
Mailing Address - Phone:818-397-0757
Mailing Address - Fax:
Practice Address - Street 1:300 E ESPLANADE DR STE 1670
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0247
Practice Address - Country:US
Practice Address - Phone:818-397-0757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No174200000XOther Service ProvidersMeals
No344600000XTransportation ServicesTaxi