Provider Demographics
NPI:1962225995
Name:DIVINE PURPOSE LLC
Entity type:Organization
Organization Name:DIVINE PURPOSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMOTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-689-6854
Mailing Address - Street 1:1075 OAKLEAF PLANTATION PKWY
Mailing Address - Street 2:SUITE 304, #181
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065
Mailing Address - Country:US
Mailing Address - Phone:904-689-6854
Mailing Address - Fax:
Practice Address - Street 1:3872 TRAIL RIDGE RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068
Practice Address - Country:US
Practice Address - Phone:904-689-6854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport