Healthcare Provider Details

I. General information

NPI: 1306294871
Provider Name (Legal Business Name): DIAMOND IN-HOME SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 S MADISON ST
MALDEN MO
63863-2109
US

IV. Provider business mailing address

129 S MADISON ST
MALDEN MO
63863-2109
US

V. Phone/Fax

Practice location:
  • Phone: 573-276-2254
  • Fax: 573-276-2295
Mailing address:
  • Phone: 573-276-2254
  • Fax: 573-276-2295

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA DELL
Title or Position: MEMBER
Credential:
Phone: 573-276-2254