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General NPI Number Information
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NPI Number | 1922696616
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Entity Type | Organization
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Legal Business Name | DIAMOND AGE CENTER, LLC
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 4889 SINCLAIR RD STE 101
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City | COLUMBUS
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State | OH
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Zip | 43229-5433
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Country | US
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Telephone | 614-859-2507
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Fax |
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Provider Business Mailing Address
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Address Line | 2403 ASHPOINT ST
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City | COLUMBUS
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State | OH
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Zip | 43219-6202
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Country | US
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Telephone | 614-218-3630
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | FARHIYO EGAL
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Credential |
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Telephone | 614-407-5030
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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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