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General NPI Number Information
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NPI Number | 1518157676
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Entity Type | Organization
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Legal Business Name | DIAMOND LIVERY, LLC
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 407 WHITNEY ST
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City | NORTHBOROUGH
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State | MA
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Zip | 01532-1153
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Country | US
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Telephone | 508-393-9393
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Fax | 508-393-0591
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Provider Business Mailing Address
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Address Line | 407 WHITNEY ST
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City | NORTHBOROUGH
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State | MA
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Zip | 01532-1153
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Country | US
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Telephone | 508-393-9393
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Fax | 508-393-0591
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Authorized Official
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Title or Position | CEO
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Name | MR. JAMES J BRADY
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Credential |
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Telephone | 508-393-9393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | S53085850
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License Number State | MA
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