Healthcare Provider Details

I. General information

NPI: 1720149495
Provider Name (Legal Business Name): DESTINY (MEDICAL) TRANSPORTATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3953 E 71ST ST
CLEVELAND OH
44105-7312
US

IV. Provider business mailing address

3953 E 71ST ST
CLEVELAND OH
44105-7312
US

V. Phone/Fax

Practice location:
  • Phone: 216-883-4302
  • Fax: 216-883-2657
Mailing address:
  • Phone: 216-883-4302
  • Fax: 216-883-2657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number2500770
License Number StateOH

VIII. Authorized Official

Name: MR. KAMORU S ADIO
Title or Position: PRESIDENT
Credential:
Phone: 216-883-4302