Provider Demographics
NPI:1447810676
Name:DESTINATION TRANSPORTATION LLC
Entity type:Organization
Organization Name:DESTINATION TRANSPORTATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRIUS
Authorized Official - Middle Name:UNGELL
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:504-905-8313
Mailing Address - Street 1:1905 VAN ARPEL DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-6336
Mailing Address - Country:US
Mailing Address - Phone:504-905-8313
Mailing Address - Fax:504-285-2185
Practice Address - Street 1:1905 VAN ARPEL DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-6336
Practice Address - Country:US
Practice Address - Phone:504-905-8313
Practice Address - Fax:504-285-2185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)