Provider Demographics
NPI:1588134019
Name:DIAMOND HOME HEALTH AGENCY LLC
Entity type:Organization
Organization Name:DIAMOND HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-510-5660
Mailing Address - Street 1:340 SUCCESS AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2443
Mailing Address - Country:US
Mailing Address - Phone:171-851-0566
Mailing Address - Fax:
Practice Address - Street 1:340 SUCCESS AVE APT 11
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2443
Practice Address - Country:US
Practice Address - Phone:718-510-5660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care