Healthcare Provider Details

I. General information

NPI: 1003865452
Provider Name (Legal Business Name): DIAMOND REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 E YANDELL DR
EL PASO TX
79925-3350
US

IV. Provider business mailing address

5721 E YANDELL DR
EL PASO TX
79925-3350
US

V. Phone/Fax

Practice location:
  • Phone: 915-778-1796
  • Fax: 915-778-8150
Mailing address:
  • Phone: 915-778-1796
  • Fax: 915-778-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateTX

VIII. Authorized Official

Name: SAMUEL DE AVILA
Title or Position: ADMINISTRATOR
Credential:
Phone: 915-778-1796