Provider Demographics
NPI:1487228904
Name:DIAMOND ENTERPRIZE LLC
Entity Type:Organization
Organization Name:DIAMOND ENTERPRIZE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-243-7916
Mailing Address - Street 1:124 N. WATER ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107
Mailing Address - Country:US
Mailing Address - Phone:847-243-7916
Mailing Address - Fax:
Practice Address - Street 1:124 N. WATER ST
Practice Address - Street 2:SUITE 208
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107
Practice Address - Country:US
Practice Address - Phone:815-977-3351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care