MEDICARE: DIAMOND 4 INC

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

General Provider Information

NPI Number	:	1861749749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAMOND 4 INC

Provider Business Mailing Address
First Line	:	6220 S ORANGE BLOSSOM TRL
Second Line	:	SUITE 173
City	:	ORLANDO
State	:	FL
Zip	:	32809-4630
Country	:	US
Telephone Number	:	407-203-3926
Fax Number	:	407-203-3927

Provider Business Practice Location Address
First Line	:	6220 S ORANGE BLOSSOM TRL
Second Line	:	SUITE 173
City	:	ORLANDO
State	:	FL
Zip	:	32809-4630
Country	:	US
Telephone Number	:	407-203-3926
Fax Number	:	407-203-3927

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEN W BAKER
Credential	:
Telephone Number	:	321-200-7978

Provider Enumeration Date	:	08/09/2012
Last Update Date	:	08/09/2012

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