Provider Demographics
NPI:1134747330
Name:DIVERSE SUPPORT AND CONSULTING SERVICES LLC
Entity type:Organization
Organization Name:DIVERSE SUPPORT AND CONSULTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-417-8929
Mailing Address - Street 1:2390 MILL RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-6081
Mailing Address - Country:US
Mailing Address - Phone:708-417-8929
Mailing Address - Fax:844-325-0412
Practice Address - Street 1:2390 MILL RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-6081
Practice Address - Country:US
Practice Address - Phone:717-798-3645
Practice Address - Fax:877-688-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care