Organization
DIVINE DRIVE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY DOUGLAS (PRESIDENT)
(630) 398-2370
Entity
Organization
Contact information
Practice address
1256 W JEFFERSON ST, 104, JOLIET, IL 60435-6886
(815) 582-4711
(815) 846-8445
Mailing address
1256 W JEFFERSON ST, 104, JOLIET, IL 60435-6886
(815) 582-4711
(815) 846-8445
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
05/14/2015
Last updated
05/14/2015
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