Healthcare Provider Details

I. General information

NPI: 1316800584
Provider Name (Legal Business Name): DIVINE CARE TRANSIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3714 NELSON DR
SAINT LOUIS MO
63121-3410
US

IV. Provider business mailing address

3714 NELSON DR
SAINT LOUIS MO
63121-3410
US

V. Phone/Fax

Practice location:
  • Phone: 557-219-4824
  • Fax:
Mailing address:
  • Phone: 557-219-4824
  • 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: JAMES BOLDEN
Title or Position: OWNER
Credential:
Phone: 557-219-4824