=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245627389
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIVINE ELEVATION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2015
-----------------------------------------------------
Last Update Date | 10/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1251 N ARDENWOOD DR APT 284
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70806-1954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-319-7247
-----------------------------------------------------
Fax | 713-490-9226
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6210 ALLENDALE RIDGE TRL
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77407-1048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-319-7247
-----------------------------------------------------
Fax | 713-490-9226
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. OKECHUKWU IKECHUKWU OKAFOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 504-319-7247
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------