Provider Demographics
NPI:1063276392
Name:DIANE PERSONAL CARE AGENCY LLC
Entity type:Organization
Organization Name:DIANE PERSONAL CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLGHEN
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:OCEAN SAINTELUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-889-0514
Mailing Address - Street 1:154 W 600 S UNIT 231
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84101-2782
Mailing Address - Country:US
Mailing Address - Phone:801-889-0514
Mailing Address - Fax:
Practice Address - Street 1:154 W 600 S UNIT 231
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84101-2782
Practice Address - Country:US
Practice Address - Phone:801-889-0514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care