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General NPI Number Information
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NPI Number | 1205646387
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Entity Type | Organization
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Legal Business Name | DIAMOND POINTE ASSISTED LIVING FACILITY
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 71871 10TH AVE
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City | SOUTH HAVEN
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State | MI
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Zip | 49090-9132
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Country | US
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Telephone | 269-214-2142
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 175
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City | SOUTH HAVEN
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State | MI
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Zip | 49090-0175
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Country | US
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Telephone | 269-214-2142
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DORTHIE BOLDEN
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Credential | REGISTERED NURSE
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Telephone | 269-214-2142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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