Provider Demographics
NPI:1720300346
Name:DIVERSE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:DIVERSE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAVINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-667-5951
Mailing Address - Street 1:3620 N SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63107-2220
Mailing Address - Country:US
Mailing Address - Phone:314-667-5951
Mailing Address - Fax:
Practice Address - Street 1:4200 UNION BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-1227
Practice Address - Country:US
Practice Address - Phone:314-667-5951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care