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General NPI Number Information
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NPI Number | 1144804519
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Entity Type | Organization
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Legal Business Name | DIAMOND DIVA EMPOWERMENT FOUNDATION INITIATIVE 2DEF
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1027 S VANDEVENTER AVE FL 6
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City | SAINT LOUIS
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State | MO
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Zip | 63110-3854
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Country | US
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Telephone | 314-328-4348
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Fax |
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Provider Business Mailing Address
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Address Line | 1027 S VANDEVENTER AVE FL 6
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City | SAINT LOUIS
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State | MO
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Zip | 63110-3854
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Country | US
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Telephone | 314-328-4348
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | EDDIE ROSS
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Credential |
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Telephone | 314-328-4348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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