Provider Demographics
NPI:1790136703
Name:DIAMOND HILL OPERATOR, LLC
Entity Type:Organization
Organization Name:DIAMOND HILL OPERATOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED PERSON
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NETZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-905-6440
Mailing Address - Street 1:585 PROSPECT ST
Mailing Address - Street 2:UNIT 304
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 NEW TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-1412
Practice Address - Country:US
Practice Address - Phone:518-235-1410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
335377Medicare Oscar/Certification