Provider Demographics
NPI:1265040711
Name:DIVERSITY HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:DIVERSITY HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EVARISTO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-422-5317
Mailing Address - Street 1:2455 S HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-1638
Mailing Address - Country:US
Mailing Address - Phone:414-810-4675
Mailing Address - Fax:414-885-0877
Practice Address - Street 1:2455 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-1638
Practice Address - Country:US
Practice Address - Phone:414-810-4675
Practice Address - Fax:414-885-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No253Z00000XAgenciesIn Home Supportive Care