Provider Demographics
NPI:1770859670
Name:A' DIAMOND LIVING CENTER
Entity Type:Organization
Organization Name:A' DIAMOND LIVING CENTER
Other - Org Name:A' DIAMOND LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:IFY
Authorized Official - Middle Name:AGATHA
Authorized Official - Last Name:UZOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-630-5480
Mailing Address - Street 1:6478 CAMBRIDGE GLEN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-3903
Mailing Address - Country:US
Mailing Address - Phone:281-630-5480
Mailing Address - Fax:
Practice Address - Street 1:6478 CAMBRIDGE GLEN LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-3903
Practice Address - Country:US
Practice Address - Phone:281-630-5480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45-4885422302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-4885422Medicaid