Provider Demographics
NPI:1669288080
Name:DIAMOND PEAK HEALTH CARE LLC
Entity type:Organization
Organization Name:DIAMOND PEAK HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OURADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-220-8606
Mailing Address - Street 1:1111 N 8TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5789
Mailing Address - Country:US
Mailing Address - Phone:208-220-8606
Mailing Address - Fax:
Practice Address - Street 1:1111 N 8TH AVE STE B
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5789
Practice Address - Country:US
Practice Address - Phone:208-220-8606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health