Provider Demographics
NPI:1356053052
Name:DIANA DENNISON ENTERPRISE LLC
Entity type:Organization
Organization Name:DIANA DENNISON ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER OF BUSINESS
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:CNA/MED-TECH
Authorized Official - Phone:843-304-7566
Mailing Address - Street 1:5460 HIGHMARKET STREET
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440
Mailing Address - Country:US
Mailing Address - Phone:843-304-7566
Mailing Address - Fax:
Practice Address - Street 1:5460 HIGHMARKET STREET
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440
Practice Address - Country:US
Practice Address - Phone:843-304-7566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIANA DENNISON ENTERPRISE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty