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General NPI Number Information
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NPI Number | 1841718111
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Entity Type | Organization
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Legal Business Name | DIVINE HEARTS TRANSPORTATION LLC
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1089 KINKEAD AVE STE 105
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-2840
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Country | US
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Telephone | 844-290-0930
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Fax | 716-389-0560
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Provider Business Mailing Address
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Address Line | 1089 KINKEAD AVE STE 105
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-2840
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Country | US
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Telephone | 844-290-0930
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Fax | 716-389-0560
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Authorized Official
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Title or Position | OWNER
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Name | ILLYASU HARUNA
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Credential | CEO
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Telephone | 844-290-0930
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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 | 04679329
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License Number State | NY
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