Basic Information
| Provider Information | |||||||||
| NPI: | 1750004222 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DIVERSIFIED ENDEAVORS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 N DUNE TRL | ||||||||
| Address2: | |||||||||
| City: | INVERNESS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344531411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522012243 | ||||||||
| FaxNumber: | 3525816230 | ||||||||
| Practice Location | |||||||||
| Address1: | 1040 N DUNE TRL | ||||||||
| Address2: | |||||||||
| City: | INVERNESS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344531411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522012243 | ||||||||
| FaxNumber: | 3525816230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2022 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | CRITCHFIELD | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3522012243 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 343900000X | Y | Transportation Services | Non-emergency Medical Transport (VAN) |
No ID Information.