Provider Demographics
NPI:1316432123
Name:DIVINE MERCY TRANSPORTATION
Entity type:Organization
Organization Name:DIVINE MERCY TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEOBUA
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:313-598-1010
Mailing Address - Street 1:28816 SPRING ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2880
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:248-796-8128
Practice Address - Street 1:28816 SPRING ARBOR DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2880
Practice Address - Country:US
Practice Address - Phone:313-598-1010
Practice Address - Fax:248-796-8128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)