Provider Demographics
NPI:1518157676
Name:DIAMOND LIVERY, LLC
Entity Type:Organization
Organization Name:DIAMOND LIVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-393-9393
Mailing Address - Street 1:407 WHITNEY ST
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-1153
Mailing Address - Country:US
Mailing Address - Phone:508-393-9393
Mailing Address - Fax:508-393-0591
Practice Address - Street 1:407 WHITNEY ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1153
Practice Address - Country:US
Practice Address - Phone:508-393-9393
Practice Address - Fax:508-393-0591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS53085850343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)