Healthcare Provider Details

I. General information

NPI: 1730018730
Provider Name (Legal Business Name): DIVERSITY HEALTHCARE 'LLC'
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 2ND ST NE
WINTER HAVEN FL
33881-4103
US

IV. Provider business mailing address

435 2ND ST NE
WINTER HAVEN FL
33881-4103
US

V. Phone/Fax

Practice location:
  • Phone: 863-419-4422
  • Fax: 833-795-1975
Mailing address:
  • Phone: 863-419-4422
  • Fax: 833-795-1975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CLAYTON DALE REEDY
Title or Position: CEO
Credential:
Phone: 937-307-7891