Organization
DIVINE ROYAL CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VICTOR O. WAGIDI 05/05/1957 (EXECUTIVE DIRECTOR)
(303) 695-6684
Entity
Organization
Contact information
Practice address
25086 E 4TH PL, AURORA, CO 80018-1687
(303) 695-6684
(303) 856-3389
Mailing address
25086 E 4TH PL, AURORA, CO 80018-1687
(303) 695-6684
(303) 856-3389
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
34675272
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14689740
—
CO
05
—
34675272
—
CO
05
—
64638073
—
CO
Enumeration date
08/13/2015
Last updated
08/13/2015
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