=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982928032
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIAMOND HOME HEALTH CARE AND STAFFING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2010
-----------------------------------------------------
Last Update Date | 03/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 911 SHINING WIRE WAY
-----------------------------------------------------
City | MORRISVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27560-5736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-376-6388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 911 SHINING WIRE WAY
-----------------------------------------------------
City | MORRISVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27560-5736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-376-6388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. EMMANUEL CHIDI OKORO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-376-6388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC4046
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------