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General NPI Number Information
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NPI Number | 1023913126
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Entity Type | Organization
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Legal Business Name | DIAMOND HOME & COMMUNITY SUPPORT SERVICE
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 7520 BRUNSWICK AVE N STE 2
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City | BROOKLYN PARK
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State | MN
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Zip | 55443-2970
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Country | US
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Telephone | 763-298-2155
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Fax | 763-200-9061
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Provider Business Mailing Address
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Address Line | 14240 43RD AVE N APT A
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City | MINNEAPOLIS
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State | MN
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Zip | 55446-3626
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Country | US
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Telephone | 763-298-2155
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Fax | 763-200-9061
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Authorized Official
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Title or Position | OWNER AND DESIGNATED ADMINISTRATOR
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Name | HERRON GBIDI
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Credential |
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Telephone | 763-501-0407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State | NULL
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