Healthcare Provider Details

I. General information

NPI: 1508564600
Provider Name (Legal Business Name): DIAMOND LUX ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6102 79TH ST UNIT B
LUBBOCK TX
79424-8714
US

IV. Provider business mailing address

6102 79TH ST UNIT B
LUBBOCK TX
79424-8714
US

V. Phone/Fax

Practice location:
  • Phone: 806-773-4599
  • Fax:
Mailing address:
  • Phone: 806-773-4599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. ALISCIA BRORMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 806-773-4599