Provider Demographics
NPI:1215627419
Name:DIVINE HEALTHCARE STAFFING AND TRANSPORTATION SERVICES
Entity type:Organization
Organization Name:DIVINE HEALTHCARE STAFFING AND TRANSPORTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-458-1869
Mailing Address - Street 1:2620 CENTENARY BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3350
Mailing Address - Country:US
Mailing Address - Phone:318-869-1330
Mailing Address - Fax:
Practice Address - Street 1:2620 CENTENARY BLVD STE 216
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3350
Practice Address - Country:US
Practice Address - Phone:318-869-1330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)