MEDICARE: DIVERSE SUPPORT AND CONSULTING SERVICES LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1134747330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSE SUPPORT AND CONSULTING SERVICES LLC

Provider Business Mailing Address
First Line	:	2390 MILL RD
Second Line	:
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-6081
Country	:	US
Telephone Number	:	708-417-8929
Fax Number	:	844-325-0412

Provider Business Practice Location Address
First Line	:	2390 MILL RD
Second Line	:
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-6081
Country	:	US
Telephone Number	:	717-798-3645
Fax Number	:	877-688-2251

Authorized Official
Title or Position	:	OWNER / PRESIDENT
Name	:	MONIQUE BELLAMY
Credential	:
Telephone Number	:	708-417-8929

Provider Enumeration Date	:	07/14/2020
Last Update Date	:	07/14/2020

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