Provider Demographics
NPI:1538704069
Name:DIAMOND MOON HOME CARE LLC
Entity Type:Organization
Organization Name:DIAMOND MOON HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NIFICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEGELEUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-519-3803
Mailing Address - Street 1:167 BALDWIN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1800
Mailing Address - Country:US
Mailing Address - Phone:203-519-3803
Mailing Address - Fax:
Practice Address - Street 1:167 BALDWIN AVE STE 2
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1800
Practice Address - Country:US
Practice Address - Phone:203-519-3803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care