Healthcare Provider Details

I. General information

NPI: 1104778778
Provider Name (Legal Business Name): DIVINE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 LIME AVE APT 10
LONG BEACH CA
90802-5245
US

IV. Provider business mailing address

47 LIME AVE APT 10
LONG BEACH CA
90802-5245
US

V. Phone/Fax

Practice location:
  • Phone: 310-651-4373
  • Fax:
Mailing address:
  • Phone: 310-651-4373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: FITSUM ALEMAYEHU
Title or Position: CEO
Credential: ALEMAYEHU
Phone: 310-651-4373