MEDICARE: A' DIAMOND LIVING CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization	45-4885422	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770859670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A' DIAMOND LIVING CENTER

Provider Business Mailing Address
First Line	:	6478 CAMBRIDGE GLEN LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-3903
Country	:	US
Telephone Number	:	281-630-5480
Fax Number	:

Provider Business Practice Location Address
First Line	:	6478 CAMBRIDGE GLEN LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-3903
Country	:	US
Telephone Number	:	281-630-5480
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. IFY AGATHA UZOH
Credential	:
Telephone Number	:	281-630-5480

Provider Enumeration Date	:	03/26/2012
Last Update Date	:	03/26/2012

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Directions to “A' DIAMOND LIVING CENTER ” Practice Location

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