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General NPI Number Information
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NPI Number | 1093280281
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Entity Type | Organization
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Legal Business Name | DIAMOND CARE SANTA FE LLC
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 12/03/2018
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Provider Practice Location Address
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Address Line | 635 HARKLE ROAD
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City | SANTA FE
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State | NM
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Zip | 87505
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Country | US
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Telephone | 505-982-2574
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Fax | 505-988-1942
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Provider Business Mailing Address
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Address Line | 807 W. LONGHORN RD.
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City | PAYSON
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State | AZ
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Zip | 85541
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Country | US
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Telephone | 928-978-0520
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Fax | 928-474-0505
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | MR. MATTHEW MEYER
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Credential |
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Telephone | 480-652-5628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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