Provider Demographics
NPI:1225544570
Name:DIAMOND HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:DIAMOND HEALTHCARE SERVICES LLC
Other - Org Name:SWIFT MEDI-TRANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IFEOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:EZENNIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:469-626-0152
Mailing Address - Street 1:102 N SHILOH RD STE 212
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-6694
Mailing Address - Country:US
Mailing Address - Phone:469-626-0152
Mailing Address - Fax:469-626-0153
Practice Address - Street 1:102 N SHILOH RD STE 212
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6694
Practice Address - Country:US
Practice Address - Phone:469-626-0152
Practice Address - Fax:469-626-0153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-22
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX018598251E00000X
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX382751101Medicaid