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General NPI Number Information
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NPI Number | 1437463064
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Entity Type | Organization
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Legal Business Name | DIAMOND JANE'S, INC.
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 08/06/2010
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Provider Practice Location Address
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Address Line | 345 S HALE ST
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City | GRANTSVILLE
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State | UT
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Zip | 84029-9546
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Country | US
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Telephone | 435-809-3918
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Fax |
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Provider Business Mailing Address
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Address Line | 345 S HALE ST
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City | GRANTSVILLE
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State | UT
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Zip | 84029-9546
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Country | US
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Telephone | 435-809-3918
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MAUREEN B PETERSON
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Credential |
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Telephone | 435-579-4402
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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 | 2009-ALII-90309
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License Number State | UT
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