Provider Demographics
NPI:1992505176
Name:DIVERSECARE LLC
Entity type:Organization
Organization Name:DIVERSECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:ITEPU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-669-6901
Mailing Address - Street 1:144 E SNOWY EGRET AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-2913
Mailing Address - Country:US
Mailing Address - Phone:801-669-6901
Mailing Address - Fax:
Practice Address - Street 1:144 E SNOWY EGRET AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-2913
Practice Address - Country:US
Practice Address - Phone:801-669-6901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care