Provider Demographics
NPI:1679932974
Name:DIAMOND ALF LLC
Entity Type:Organization
Organization Name:DIAMOND ALF LLC
Other - Org Name:DIAMOND ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHDJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-590-2998
Mailing Address - Street 1:11545 DELWICK DR
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6081
Mailing Address - Country:US
Mailing Address - Phone:407-226-7110
Mailing Address - Fax:800-531-2072
Practice Address - Street 1:3339 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-3797
Practice Address - Country:US
Practice Address - Phone:904-863-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12748310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility