Provider Demographics
NPI:1205373487
Name:DIAMOND HOME CARE OF VA, LLC
Entity Type:Organization
Organization Name:DIAMOND HOME CARE OF VA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDUFFIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-531-0229
Mailing Address - Street 1:21715 INDIAN SUMMER TER
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-9008
Mailing Address - Country:US
Mailing Address - Phone:301-531-0229
Mailing Address - Fax:
Practice Address - Street 1:21715 INDIAN SUMMER TER
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-9008
Practice Address - Country:US
Practice Address - Phone:301-531-0229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health