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General NPI Number Information
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NPI Number | 1265040711
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Entity Type | Organization
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Legal Business Name | DIVERSITY HOME HEALTH SERVICES
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 2455 S HOWELL AVE
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City | MILWAUKEE
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State | WI
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Zip | 53207-1638
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Country | US
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Telephone | 414-810-4675
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Fax | 414-885-0877
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Provider Business Mailing Address
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Address Line | 2455 S HOWELL AVE
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City | MILWAUKEE
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State | WI
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Zip | 53207-1638
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Country | US
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Telephone | 414-810-4675
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Fax | 414-885-0877
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. EVARISTO ANTONIO RODRIGUEZ
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Credential |
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Telephone | 414-422-5317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care 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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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