Healthcare Provider Details

I. General information

NPI: 1083829501
Provider Name (Legal Business Name): DIVERSIFIED HEALTH MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2691 E MAIN ST STE BE25
BEXLEY OH
43209-2535
US

IV. Provider business mailing address

3569 REFUGEE RD. SUITE C.
COLUMBUS OH
43232
US

V. Phone/Fax

Practice location:
  • Phone: 614-338-8888
  • Fax: 614-338-8030
Mailing address:
  • Phone: 614-338-8888
  • Fax: 614-338-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number52-640127
License Number StateOH

VIII. Authorized Official

Name: ALEX S PHOMMASATHIT
Title or Position: EXECUTIVE ADMINISTRATOR
Credential:
Phone: 614-338-8888