=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285434811
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIAMOND DREAMERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2025
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 GREEN HILL MANOR DR
-----------------------------------------------------
City | FRANKLIN PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08823-2617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-880-8083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 FRANKLIN BLVD
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-1961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-881-2150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INDEPENDENT BUSINESS OWNER
-----------------------------------------------------
Name | SIABEHTI JOHN
-----------------------------------------------------
Credential | BSHM
-----------------------------------------------------
Telephone | 732-881-2150
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------