Healthcare Provider Details

I. General information

NPI: 1093280281
Provider Name (Legal Business Name): DIAMOND CARE SANTA FE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 HARKLE ROAD
SANTA FE NM
87505
US

IV. Provider business mailing address

807 W. LONGHORN RD.
PAYSON AZ
85541
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-2574
  • Fax: 505-988-1942
Mailing address:
  • Phone: 928-978-0520
  • Fax: 928-474-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW MEYER
Title or Position: OWNER OPERATOR
Credential:
Phone: 480-652-5628