Provider Demographics
NPI:1942919915
Name:DIAMONDSTAR LLC
Entity Type:Organization
Organization Name:DIAMONDSTAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-813-9438
Mailing Address - Street 1:PO BOX 761
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44005-0761
Mailing Address - Country:US
Mailing Address - Phone:440-813-9438
Mailing Address - Fax:440-539-4758
Practice Address - Street 1:2011 ORIOLE DR
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-7829
Practice Address - Country:US
Practice Address - Phone:440-813-9438
Practice Address - Fax:440-536-4758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty