MEDICARE: DIVERSE HEALTHCARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1053633321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSE HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	3556 SULLIVANT AVE
Second Line	:	SUITE 104
City	:	COLUMBUS
State	:	OH
Zip	:	43204-1153
Country	:	US
Telephone Number	:	614-279-9545
Fax Number	:

Provider Business Practice Location Address
First Line	:	3556 SULLIVANT AVE
Second Line	:	SUITE 104
City	:	COLUMBUS
State	:	OH
Zip	:	43204-1153
Country	:	US
Telephone Number	:	614-279-9545
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANETA MOSLEY
Credential	:
Telephone Number	:	614-279-9545

Provider Enumeration Date	:	02/26/2010
Last Update Date	:	02/26/2010

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