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General NPI Number Information
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NPI Number | 1679932974
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Entity Type | Organization
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Legal Business Name | DIAMOND ALF LLC
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 3339 HIGHWAY 17
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-3797
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Country | US
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Telephone | 904-863-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 11545 DELWICK DR
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City | WINDERMERE
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State | FL
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Zip | 34786-6081
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Country | US
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Telephone | 407-226-7110
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Fax | 800-531-2072
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEVE ASHDJI
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Credential |
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Telephone | 407-590-2998
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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 | AL12748
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License Number State | FL
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