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General NPI Number Information
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NPI Number | 1902744352
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Entity Type | Organization
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Legal Business Name | BLUE DIAMOND ENTERTAINMENT
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Dates
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Enumeration Date | 03/24/2026
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Last Update Date | 03/24/2026
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Provider Practice Location Address
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Address Line | 876 S ARLINGTON ST
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City | AKRON
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State | OH
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Zip | 44306-2863
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Country | US
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Telephone | 330-724-2121
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Fax | 330-724-9794
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Provider Business Mailing Address
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Address Line | 876 S ARLINGTON ST
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City | AKRON
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State | OH
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Zip | 44306-2863
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Country | US
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Telephone | 330-724-2121
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Fax | 330-724-9794
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEPHAN LEON EVANS SR.
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Credential |
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Telephone | 330-724-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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