=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356141303
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIVINE TRANSPORTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2025
-----------------------------------------------------
Last Update Date | 10/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7420 UNITY AVE N STE 302
-----------------------------------------------------
City | BROOKLYN PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55443-3136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-338-9350
-----------------------------------------------------
Fax | 612-713-9401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14596 SNOWY OWL ST NW
-----------------------------------------------------
City | RAMSEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55303-4371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-338-9350
-----------------------------------------------------
Fax | 612-713-9401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BANJELISTER M MOLLEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-338-9350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------