Provider Demographics
NPI:1265208276
Name:DIAMOND LAKE HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:DIAMOND LAKE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAMANTAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-278-1079
Mailing Address - Street 1:2942 N 24TH ST STE 114
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7849
Mailing Address - Country:US
Mailing Address - Phone:602-877-9355
Mailing Address - Fax:
Practice Address - Street 1:2942 N 24TH ST SUITE 114
Practice Address - Street 2:APT 12
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7849
Practice Address - Country:US
Practice Address - Phone:602-877-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health