Provider Demographics
NPI:1235850181
Name:DIAMONDS MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:DIAMONDS MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENTRELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-910-9659
Mailing Address - Street 1:591 E PLAZA CIR UNIT 2133
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-7685
Mailing Address - Country:US
Mailing Address - Phone:602-910-9659
Mailing Address - Fax:
Practice Address - Street 1:11417 W EDGEMONT AVE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5657
Practice Address - Country:US
Practice Address - Phone:602-910-9659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)