Provider Demographics
NPI:1023185667
Name:DIVERSIFIED HEALTH CARE INC
Entity Type:Organization
Organization Name:DIVERSIFIED HEALTH CARE INC
Other - Org Name:DIVERSIFIED HEALTH CARE INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:UBAKA
Authorized Official - Last Name:MORAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-771-5535
Mailing Address - Street 1:8200 WEDNESBURY LN STE 235
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2943
Mailing Address - Country:US
Mailing Address - Phone:713-771-5535
Mailing Address - Fax:713-771-5516
Practice Address - Street 1:8200 WEDNESBURY LN STE 235
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2943
Practice Address - Country:US
Practice Address - Phone:713-771-5535
Practice Address - Fax:713-771-5516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUINDIARA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-29
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008421251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679397Medicare PIN
TX679397Medicare Oscar/Certification