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General NPI Number Information
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NPI Number | 1538310982
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Entity Type | Organization
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Legal Business Name | DIVINITY ENTERPRISES LLC
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Dates
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Enumeration Date | 10/03/2008
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Last Update Date | 10/03/2008
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Provider Practice Location Address
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Address Line | 8075 MAGNOLIA LN N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-7177
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Country | US
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Telephone | 651-341-6390
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40365
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City | SAINT PAUL
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State | MN
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Zip | 55104-8365
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Country | US
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Telephone | 651-341-6390
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. DAVID NYAMARI NYAOSI
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Credential |
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Telephone | 651-341-6390
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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 | PENDING
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License Number State | MN
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