1326442914 NPI number — DIVINE CARE TRANSIT INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326442914 NPI number — DIVINE CARE TRANSIT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIVINE CARE TRANSIT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326442914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6117 N CLAREMONT AVE APT 3N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60659-5256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-592-9285
Provider Business Mailing Address Fax Number:
773-754-7381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6117 N CLAREMONT AVE APT 3N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60659-5256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-592-9285
Provider Business Practice Location Address Fax Number:
773-754-7381
Provider Enumeration Date:
10/10/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OHIRI
Authorized Official First Name:
PAULINE
Authorized Official Middle Name:
OYIDIYA
Authorized Official Title or Position:
MD/CEC
Authorized Official Telephone Number:
773-592-9285

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  68208726 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)