Provider Demographics
NPI:1649968298
Name:DIAMOND IN THE ROUGH CONSTRUCTION LLC
Entity type:Organization
Organization Name:DIAMOND IN THE ROUGH CONSTRUCTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-402-3934
Mailing Address - Street 1:2477 NORTHVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3514
Mailing Address - Country:US
Mailing Address - Phone:216-402-3934
Mailing Address - Fax:
Practice Address - Street 1:2477 NORTHVIEW RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3514
Practice Address - Country:US
Practice Address - Phone:216-402-3934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty