Provider Demographics
NPI:1972865087
Name:DIVERSITY FAMILY SERVICES
Entity Type:Organization
Organization Name:DIVERSITY FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-743-5908
Mailing Address - Street 1:6132 PASSIONATE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3538
Mailing Address - Country:US
Mailing Address - Phone:702-743-5908
Mailing Address - Fax:
Practice Address - Street 1:6132 PASSIONATE CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-3538
Practice Address - Country:US
Practice Address - Phone:702-743-5908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1164739017Medicaid
NV1740597715Medicaid
NV1679797633Medicaid