Healthcare Provider Details

I. General information

NPI: 1346579810
Provider Name (Legal Business Name): DIAMOND HOME HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2009
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10511 JUDICIAL DR # 120
FAIRFAX VA
22030-5114
US

IV. Provider business mailing address

10511 JUDICIAL DR # 120
FAIRFAX VA
22030-5114
US

V. Phone/Fax

Practice location:
  • Phone: 703-379-1008
  • Fax: 703-379-0844
Mailing address:
  • Phone: 703-379-1008
  • Fax: 703-379-0844

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: MR. KAYODE OGUNSIAKAN
Title or Position: ADMINISTRATIVE
Credential:
Phone: 202-361-5080