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General NPI Number Information
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NPI Number | 1790243574
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Entity Type | Organization
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Legal Business Name | BLUE DIAMOND CARE
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 4218 ROANOKE RD STE 346
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City | KANSAS CITY
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State | MO
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Zip | 64111-3198
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Country | US
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Telephone | 816-298-0205
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Fax | 816-298-0205
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Provider Business Mailing Address
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Address Line | 4218 ROANOKE RD STE 346
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City | KANSAS CITY
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State | MO
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Zip | 64111-3198
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Country | US
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Telephone | 816-298-0205
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Fax | 816-298-0205
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Authorized Official
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Title or Position | DESIGNATED MANAGER
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Name | MRS. DIANE FLANIGAN
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Credential |
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Telephone | 816-915-7504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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