Healthcare Provider Details

I. General information

NPI: 1659720209
Provider Name (Legal Business Name): DIAMONDS HANDS FAMILY HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2016
Last Update Date: 02/10/2024
Certification Date: 02/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4266 LINDSEY DR
DECATUR GA
30035-1927
US

IV. Provider business mailing address

4266 LINDSEY DR
DECATUR GA
30035-1927
US

V. Phone/Fax

Practice location:
  • Phone: 470-965-3741
  • Fax:
Mailing address:
  • Phone: 470-965-3741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATRICE M JACKSON-WEATHERS
Title or Position: OWNER
Credential: CNA
Phone: 470-965-3741