Provider Demographics
NPI:1063741007
Name:DIVERSITY HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:DIVERSITY HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAREK
Authorized Official - Middle Name:JOZEF
Authorized Official - Last Name:GAUL
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:248-483-9220
Mailing Address - Street 1:27208 SOUTHFIELD RD
Mailing Address - Street 2:7
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-7912
Mailing Address - Country:US
Mailing Address - Phone:248-483-9220
Mailing Address - Fax:248-483-9221
Practice Address - Street 1:27208 SOUTHFIELD RD
Practice Address - Street 2:7
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-7912
Practice Address - Country:US
Practice Address - Phone:248-483-9220
Practice Address - Fax:248-483-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health