Healthcare Provider Details

I. General information

NPI: 1023913126
Provider Name (Legal Business Name): DIAMOND HOME & COMMUNITY SUPPORT SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 BRUNSWICK AVE N STE 2
BROOKLYN PARK MN
55443-2970
US

IV. Provider business mailing address

14240 43RD AVE N APT A
MINNEAPOLIS MN
55446-3626
US

V. Phone/Fax

Practice location:
  • Phone: 763-298-2155
  • Fax: 763-200-9061
Mailing address:
  • Phone: 763-298-2155
  • Fax: 763-200-9061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: HERRON GBIDI
Title or Position: OWNER AND DESIGNATED ADMINISTRATOR
Credential:
Phone: 763-501-0407