Healthcare Provider Details

I. General information

NPI: 1871166520
Provider Name (Legal Business Name): DIVERGENT CARE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 BISCAYNE BLVD STE 203
MIAMI FL
33137-3255
US

IV. Provider business mailing address

4300 BISCAYNE BLVD STE 203
MIAMI FL
33137-3255
US

V. Phone/Fax

Practice location:
  • Phone: 800-681-1309
  • Fax:
Mailing address:
  • Phone: 866-949-1048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. DENEA GIBBS
Title or Position: OWNER
Credential:
Phone: 786-585-1990