Provider Demographics
NPI:1083829501
Name:DIVERSIFIED HEALTH MANAGEMENT, INC.
Entity Type:Organization
Organization Name:DIVERSIFIED HEALTH MANAGEMENT, INC.
Other - Org Name:DHM AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:S
Authorized Official - Last Name:PHOMMASATHIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-338-8888
Mailing Address - Street 1:3569 REFUGEE RD.
Mailing Address - Street 2:SUITE C.
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232
Mailing Address - Country:US
Mailing Address - Phone:614-338-8888
Mailing Address - Fax:614-338-8030
Practice Address - Street 1:3569 REFUGEE RD
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-9306
Practice Address - Country:US
Practice Address - Phone:614-338-8888
Practice Address - Fax:614-338-8030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH52-640127251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3041210Medicaid
OH36D1047625OtherCLIA