Provider Demographics
NPI:1962967836
Name:DIVERSE MEDICAL GROUP, INC
Entity type:Organization
Organization Name:DIVERSE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LEYSI
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-797-0300
Mailing Address - Street 1:8040 NW 95TH ST STE 225
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2361
Mailing Address - Country:US
Mailing Address - Phone:786-797-0300
Mailing Address - Fax:305-675-2443
Practice Address - Street 1:8040 NW 95TH ST STE 225
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2361
Practice Address - Country:US
Practice Address - Phone:305-951-8777
Practice Address - Fax:305-675-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health