MEDICARE: DIVERSITY HEALTHCARE '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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1730018730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSITY HEALTHCARE 'LLC'

Provider Business Mailing Address
First Line	:	435 2ND ST NE
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4103
Country	:	US
Telephone Number	:	863-419-4422
Fax Number	:	833-795-1975

Provider Business Practice Location Address
First Line	:	435 2ND ST NE
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4103
Country	:	US
Telephone Number	:	863-419-4422
Fax Number	:	833-795-1975

Authorized Official
Title or Position	:	CEO
Name	:	CLAYTON DALE REEDY
Credential	:
Telephone Number	:	937-307-7891

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/15/2026

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Practice Fax:

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