Provider Demographics
NPI:1841600434
Name:DIVERSIFIED CONTRACTORS, LLC
Entity Type:Organization
Organization Name:DIVERSIFIED CONTRACTORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:CRAIGHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:276-692-6092
Mailing Address - Street 1:1731 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:VA
Mailing Address - Zip Code:24165-3057
Mailing Address - Country:US
Mailing Address - Phone:276-692-6092
Mailing Address - Fax:276-957-2402
Practice Address - Street 1:1731 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:VA
Practice Address - Zip Code:24165-3057
Practice Address - Country:US
Practice Address - Phone:276-692-6092
Practice Address - Fax:276-957-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001153362305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization