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General NPI Number Information
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NPI Number | 1124813373
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Entity Type | Organization
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Legal Business Name | DESTINY TRANSPORTATION LLC
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 5838 N 117TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53225-2208
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Country | US
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Telephone | 414-514-4555
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Fax |
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Provider Business Mailing Address
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Address Line | 5838 N 117TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53225-2208
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Country | US
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Telephone | 414-514-4555
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | LARRY DAVION SEPHUS II
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Credential |
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Telephone | 414-514-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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