Provider Demographics
NPI:1184163529
Name:DIAMONDS OF MY HEART LLC
Entity type:Organization
Organization Name:DIAMONDS OF MY HEART LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADULT CARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:STATE OF MI LICENSED
Authorized Official - Phone:586-745-1752
Mailing Address - Street 1:14419 E 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2446
Mailing Address - Country:US
Mailing Address - Phone:586-745-1752
Mailing Address - Fax:
Practice Address - Street 1:14419 E 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-2446
Practice Address - Country:US
Practice Address - Phone:586-745-1752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X, 385H00000X, 104100000X, 174200000X, 261QA0600X, 174200000X
MIAS500357984251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
No385H00000XRespite Care FacilityRespite Care
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No174200000XOther Service ProvidersMeals
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1043759442OtherMEDICARE
MI1184163529OtherMEDICARE
MIAS500357984OtherSTATE OF MI
MIAS500357984Medicaid