MEDICARE: DIVINE CARE TRANSIT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1316800584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE CARE TRANSIT LLC

Provider Business Mailing Address
First Line	:	3714 NELSON DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-3410
Country	:	US
Telephone Number	:	557-219-4824
Fax Number	:

Provider Business Practice Location Address
First Line	:	3714 NELSON DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-3410
Country	:	US
Telephone Number	:	557-219-4824
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES BOLDEN
Credential	:
Telephone Number	:	557-219-4824

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/11/2025

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