Healthcare Provider Details

I. General information

NPI: 1730930454
Provider Name (Legal Business Name): THE DIAMOND FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5892 LOSEE RD STE 132-330
NORTH LAS VEGAS NV
89081-6599
US

IV. Provider business mailing address

5892 LOSEE RD STE 132-330
NORTH LAS VEGAS NV
89081-6599
US

V. Phone/Fax

Practice location:
  • Phone: 504-237-2733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SEBERN COLEMAN
Title or Position: PRESIDENT
Credential: PH.D
Phone: 504-237-2733