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General NPI Number Information
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NPI Number | 1801103429
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Entity Type | Organization
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Legal Business Name | DEVINE SERVICES INC
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 20055 MONTEREY AVE
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City | LYNWOOD
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State | IL
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Zip | 60411-1517
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Country | US
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Telephone | 708-228-9241
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5022
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City | LANSING
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State | IL
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Zip | 60438-5022
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Country | US
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Telephone | 708-228-9241
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. LA ROYCE A CLAY
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Credential |
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Telephone | 708-228-9241
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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 | IL
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