Healthcare Provider Details

I. General information

NPI: 1659776433
Provider Name (Legal Business Name): DIVERSE ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11805 N PENNSYLVANIA ST
CARMEL IN
46032-4555
US

IV. Provider business mailing address

11805 N PENNSYLVANIA ST
CARMEL IN
46032-4555
US

V. Phone/Fax

Practice location:
  • Phone: 317-735-6366
  • Fax:
Mailing address:
  • Phone: 317-735-6366
  • 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 Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateIN

VIII. Authorized Official

Name: HENRIETTA RUDY
Title or Position: OWNER
Credential: RN
Phone: 317-735-6366