Healthcare Provider Details

I. General information

NPI: 1053683169
Provider Name (Legal Business Name): DIVERSE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2012
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BRYDEN RD # 121
COLUMBUS OH
43215
US

IV. Provider business mailing address

700 BRYDEN RD # 121
COLUMBUS OH
43215-4839
US

V. Phone/Fax

Practice location:
  • Phone: 614-222-0899
  • Fax: 614-222-0899
Mailing address:
  • Phone: 614-222-0899
  • Fax: 614-222-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GUURE F ISSA
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 614-222-0899