Provider Demographics
NPI:1134696990
Name:DIAMOND ADULT DAY SERVICES LLC
Entity Type:Organization
Organization Name:DIAMOND ADULT DAY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:SHEIKH
Authorized Official - Last Name:ROBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-990-5187
Mailing Address - Street 1:1790 LEXINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6167
Mailing Address - Country:US
Mailing Address - Phone:507-990-5187
Mailing Address - Fax:866-597-0950
Practice Address - Street 1:1790 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-6167
Practice Address - Country:US
Practice Address - Phone:507-990-5187
Practice Address - Fax:866-597-0950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherADULT DAY SERVICES
MN=========Medicaid