Provider Demographics
NPI:1639544521
Name:DIVERSIFIED CARE, LLC
Entity Type:Organization
Organization Name:DIVERSIFIED CARE, LLC
Other - Org Name:DIVERSIFIED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TA NISHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAULDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-448-8534
Mailing Address - Street 1:331 E MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-5371
Mailing Address - Country:US
Mailing Address - Phone:803-448-8534
Mailing Address - Fax:
Practice Address - Street 1:331 E MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-5371
Practice Address - Country:US
Practice Address - Phone:803-448-8534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP0477253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care