MEDICARE: DIAMOND HOME CARE AGENCY LLC

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	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1861200875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAMOND HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	12900 MEDFORD RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-2013
Country	:	US
Telephone Number	:	215-651-2413
Fax Number	:

Provider Business Practice Location Address
First Line	:	12900 MEDFORD RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-2013
Country	:	US
Telephone Number	:	215-651-2413
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MIRNA MEDINA
Credential	:
Telephone Number	:	215-651-2413

Provider Enumeration Date	:	12/21/2024
Last Update Date	:	12/21/2024

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