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General NPI Number Information
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NPI Number | 1861200875
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Entity Type | Organization
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Legal Business Name | DIAMOND HOME CARE AGENCY LLC
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Dates
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Enumeration Date | 12/21/2024
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 12900 MEDFORD RD
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City | PHILADELPHIA
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State | PA
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Zip | 19154-2013
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Country | US
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Telephone | 215-651-2413
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Fax |
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Provider Business Mailing Address
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Address Line | 12900 MEDFORD RD
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City | PHILADELPHIA
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State | PA
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Zip | 19154-2013
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Country | US
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Telephone | 215-651-2413
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MIRNA MEDINA
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Credential |
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Telephone | 215-651-2413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home 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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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