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General NPI Number Information
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NPI Number | 1063578417
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Entity Type | Organization
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Legal Business Name | DIVERSITY HOME HEALTH CARE, INC.
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 565 UNIVERSITY AVE W SUITE 213
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City | SAINT PAUL
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State | MN
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Zip | 55103-1960
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Country | US
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Telephone | 651-224-2201
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Fax | 651-224-0881
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Provider Business Mailing Address
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Address Line | 565 UNIVERSITY AVE W SUITE 213
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City | SAINT PAUL
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State | MN
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Zip | 55103-1960
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Country | US
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Telephone | 651-224-2201
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Fax | 651-224-0881
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIA MOUA KHANG
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Credential |
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Telephone | 651-224-2201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 21984
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License Number State | MN
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