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General NPI Number Information
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NPI Number | 1669288080
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Entity Type | Organization
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Legal Business Name | DIAMOND PEAK HEALTH CARE LLC
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 1111 N 8TH AVE STE B
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City | POCATELLO
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State | ID
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Zip | 83201-5789
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Country | US
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Telephone | 208-220-8606
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 N 8TH AVE STE B
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City | POCATELLO
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State | ID
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Zip | 83201-5789
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Country | US
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Telephone | 208-220-8606
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA ANN OURADA
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Credential |
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Telephone | 208-220-8606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health 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 | 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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