Provider Demographics
NPI:1205339017
Name:DIVINE SOLAR LLC
Entity type:Organization
Organization Name:DIVINE SOLAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHIKA
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:UDECHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-515-0342
Mailing Address - Street 1:1025 TOULOUSE ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-6101
Mailing Address - Country:US
Mailing Address - Phone:972-515-0342
Mailing Address - Fax:
Practice Address - Street 1:10505 PROVIDENCE DR UNIT 106
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-4738
Practice Address - Country:US
Practice Address - Phone:972-515-0342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-18
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)