Provider Demographics
NPI:1609340777
Name:DIAMOND GLOBAL HEALTHCARE, INC
Entity Type:Organization
Organization Name:DIAMOND GLOBAL HEALTHCARE, INC
Other - Org Name:NUMEDICAL & PSYCHIATRY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:MODUPE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:OKONOFUA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC, FNP-C
Authorized Official - Phone:817-805-9137
Mailing Address - Street 1:7244 BOREAL DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-3766
Mailing Address - Country:US
Mailing Address - Phone:719-413-5005
Mailing Address - Fax:602-955-8725
Practice Address - Street 1:6547 N ACADEMY BLVD # 1085
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8342
Practice Address - Country:US
Practice Address - Phone:719-413-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty