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General NPI Number Information
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NPI Number | 1811774367
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Entity Type | Organization
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Legal Business Name | DESTINATION TRANSIT LLC
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Dates
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Enumeration Date | 09/08/2023
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | 5078 W ADAMS ST
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City | CHICAGO
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State | IL
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Zip | 60644-4342
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Country | US
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Telephone | 708-880-9084
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Fax |
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Provider Business Mailing Address
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Address Line | 6545 W DICKENS AVE APT 2W
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City | CHICAGO
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State | IL
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Zip | 60707-3482
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Country | US
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Telephone | 708-400-0679
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KORI WILLIAMS
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Credential |
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Telephone | 708-400-0679
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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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