MEDICARE: DIVERSITY SUPPORT CARE 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1356013130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSITY SUPPORT CARE LLC

Provider Business Mailing Address
First Line	:	2680 N HAVEN BLVD
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44223-2124
Country	:	US
Telephone Number	:	330-794-5716
Fax Number	:

Provider Business Practice Location Address
First Line	:	2680 N HAVEN BLVD
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44223-2124
Country	:	US
Telephone Number	:	330-794-5716
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MISS TINA DENISE MILES
Credential	:
Telephone Number	:	330-794-5716

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	07/29/2024

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Directions to “DIVERSITY SUPPORT CARE LLC ” Practice Location

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