Provider Demographics
NPI:1538379839
Name:DIAMOND'S COMMUNITY BASED SERVICES, INC.
Entity type:Organization
Organization Name:DIAMOND'S COMMUNITY BASED SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:LASHAWN
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-605-0927
Mailing Address - Street 1:8101 STEM CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-2569
Mailing Address - Country:US
Mailing Address - Phone:704-605-0927
Mailing Address - Fax:704-566-7858
Practice Address - Street 1:8101 STEM CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-2569
Practice Address - Country:US
Practice Address - Phone:704-605-0927
Practice Address - Fax:704-566-7858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418196Medicaid