Provider Demographics
NPI:1659912376
Name:DIAMOND PERSONAL CARE, LLC
Entity Type:Organization
Organization Name:DIAMOND PERSONAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ISCH
Authorized Official - Last Name:DESONIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-358-6180
Mailing Address - Street 1:33 MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4510
Mailing Address - Country:US
Mailing Address - Phone:501-358-6180
Mailing Address - Fax:501-504-6933
Practice Address - Street 1:33 MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4510
Practice Address - Country:US
Practice Address - Phone:501-358-6180
Practice Address - Fax:501-504-6933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1659912376Medicaid