Provider Demographics
NPI:1790807758
Name:DIVERSIFIED SUPPORTIVE SERVICES LLC
Entity Type:Organization
Organization Name:DIVERSIFIED SUPPORTIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RASHEEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-673-2778
Mailing Address - Street 1:PO BOX 45923
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-5923
Mailing Address - Country:US
Mailing Address - Phone:215-673-2778
Mailing Address - Fax:215-673-2778
Practice Address - Street 1:9200 OLD BUSTLETON AVE
Practice Address - Street 2:SUITE D-207
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19115-4642
Practice Address - Country:US
Practice Address - Phone:215-673-2778
Practice Address - Fax:215-673-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health