Provider Demographics
NPI:1205400249
Name:DIVERSITY HEALTH LLC
Entity Type:Organization
Organization Name:DIVERSITY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMANUILIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-275-0812
Mailing Address - Street 1:235 3RD AVE N UNIT 202
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3356
Mailing Address - Country:US
Mailing Address - Phone:727-275-0812
Mailing Address - Fax:
Practice Address - Street 1:235 3RD AVE N UNIT 202
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3356
Practice Address - Country:US
Practice Address - Phone:727-275-0812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies