Healthcare Provider Details

I. General information

NPI: 1134696990
Provider Name (Legal Business Name): DIAMOND ADULT DAY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 LEXINGTON AVE N
SAINT PAUL MN
55113-6167
US

IV. Provider business mailing address

1790 LEXINGTON AVE N
SAINT PAUL MN
55113-6167
US

V. Phone/Fax

Practice location:
  • Phone: 507-990-5187
  • Fax: 866-597-0950
Mailing address:
  • Phone: 507-990-5187
  • Fax: 866-597-0950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OMAR SHEIKH ROBLE
Title or Position: CEO
Credential:
Phone: 507-990-5187