Organization
DIAMOND COMMUNITY LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SIGISMUND SANYAOLU CPA (CHIEF FINANCIAL OFFICER)
(404) 510-5208
Entity
Organization
Contact information
Practice address
116 REMINGTON PLACE DR, DALLAS, GA 30157-5431
(770) 505-3467
Mailing address
741 RIVERWOOD DR, DALLAS, GA 30157-4190
(770) 505-9711
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
11001016-2
GA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
11001020-2
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
673223392B
—
GA
05
—
673223392C
—
GA
Enumeration date
01/04/2011
Last updated
01/04/2011
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