Healthcare Provider Details

I. General information

NPI: 1861309478
Provider Name (Legal Business Name): DOROTHY RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEVINE CARE TRANSPORTATION

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12481 SANDERS ST
SCOOBA MS
39358-7503
US

IV. Provider business mailing address

12481 SANDERS ST
SCOOBA MS
39358-7503
US

V. Phone/Fax

Practice location:
  • Phone: 769-219-7806
  • Fax:
Mailing address:
  • Phone: 769-219-7806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number801431518
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: