MEDICARE: THE DIAMOND FOUNDATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363LC1500X	Community Health Nurse Practitioner
2	251B00000X	Case Management Agency
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1730930454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DIAMOND FOUNDATION INC

Provider Business Mailing Address
First Line	:	5892 LOSEE RD STE 132-330
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6599
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5892 LOSEE RD STE 132-330
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6599
Country	:	US
Telephone Number	:	504-237-2733
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SEBERN COLEMAN
Credential	:	PH.D
Telephone Number	:	504-237-2733

Provider Enumeration Date	:	03/29/2024
Last Update Date	:	03/29/2024

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Directions to “THE DIAMOND FOUNDATION INC ” Practice Location

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