Provider Demographics
NPI:1659776433
Name:DIVERSE ENTERPRISES
Entity Type:Organization
Organization Name:DIVERSE ENTERPRISES
Other - Org Name:NURSE NEXT DOOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:317-735-6366
Mailing Address - Street 1:11805 N PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4555
Mailing Address - Country:US
Mailing Address - Phone:317-735-6366
Mailing Address - Fax:
Practice Address - Street 1:11805 N PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4555
Practice Address - Country:US
Practice Address - Phone:317-735-6366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
IN343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)