Healthcare Provider Details

I. General information

NPI: 1447795745
Provider Name (Legal Business Name): DIVERSIFIED HOME & COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5548 BOYER ST
PHILADELPHIA PA
19138-2306
US

IV. Provider business mailing address

325 CHESTNUT ST STE 876
PHILADELPHIA PA
19106-2614
US

V. Phone/Fax

Practice location:
  • Phone: 215-626-6655
  • Fax:
Mailing address:
  • Phone: 215-550-1793
  • Fax: 215-405-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. KARMA WATSON
Title or Position: DIRECTOR
Credential: MS. LBS, LPC
Phone: 215-550-1793