Provider Demographics
NPI:1841718111
Name:DIVINE HEARTS TRANSPORTATION LLC
Entity type:Organization
Organization Name:DIVINE HEARTS TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILLYASU
Authorized Official - Middle Name:
Authorized Official - Last Name:HARUNA
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:844-290-0930
Mailing Address - Street 1:1089 KINKEAD AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2840
Mailing Address - Country:US
Mailing Address - Phone:844-290-0930
Mailing Address - Fax:716-389-0560
Practice Address - Street 1:1089 KINKEAD AVE STE 105
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-2840
Practice Address - Country:US
Practice Address - Phone:844-290-0930
Practice Address - Fax:716-389-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04679329343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)