Provider Demographics
NPI:1598481657
Name:DIVERSITY IMPACTING COMMUNITIES LLC
Entity Type:Organization
Organization Name:DIVERSITY IMPACTING COMMUNITIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-509-0414
Mailing Address - Street 1:5001 BAUM BLVD STE 413
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1851
Mailing Address - Country:US
Mailing Address - Phone:412-509-0414
Mailing Address - Fax:
Practice Address - Street 1:5001 BAUM BLVD STE 413
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1851
Practice Address - Country:US
Practice Address - Phone:412-509-0414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities