Provider Demographics
NPI:1649914920
Name:DIVERSITY HEALTHCARE LLC
Entity type:Organization
Organization Name:DIVERSITY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GBUTU
Authorized Official - Last Name:NORNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:163-568-8699
Mailing Address - Street 1:5701 SHINGLE CREEK PKWY STE 350C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2485
Mailing Address - Country:US
Mailing Address - Phone:763-568-8699
Mailing Address - Fax:
Practice Address - Street 1:5701 SHINGLE CREEK PKWY STE 350C
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2485
Practice Address - Country:US
Practice Address - Phone:763-568-8699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health