Healthcare Provider Details

I. General information

NPI: 1912588468
Provider Name (Legal Business Name): DIAMOND ENTERPRIZE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N WATER ST STE 208
ROCKFORD IL
61107-3959
US

IV. Provider business mailing address

124 N WATER ST STE 208
ROCKFORD IL
61107-3959
US

V. Phone/Fax

Practice location:
  • Phone: 815-977-3351
  • Fax:
Mailing address:
  • Phone: 815-977-3351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: LOUISE MARIE CRAYTON
Title or Position: PRESIDENT
Credential: N/A
Phone: 847-243-7916