Healthcare Provider Details

I. General information

NPI: 1184507345
Provider Name (Legal Business Name): BLUE DIAMOND GROUP HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5415 CLAIRTON BLVD
PITTSBURGH PA
15236-2714
US

IV. Provider business mailing address

1360 ARMITAGE WAY
MECHANICSBURG PA
17050-6403
US

V. Phone/Fax

Practice location:
  • Phone: 469-235-0302
  • Fax:
Mailing address:
  • Phone: 469-235-0302
  • Fax: 469-235-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BHUPAL ODARI
Title or Position: OWNER
Credential:
Phone: 469-235-0302