Organization
DIAMOND SUPPORTED LIVING SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAZENA E. KENNEDY (CHIEF EXECUTIVE OFFICER)
(904) 307-6844
Entity
Organization
Contact information
Practice address
330 IVY ST, JACKSONVILLE, FL 32206-6350
(904) 307-6844
(904) 924-1174
Mailing address
PO BOX 2678, JACKSONVILLE, FL 32203-2678
(904) 307-6844
(904) 924-1174
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
687831896 68783189
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
687831896 687831898
—
FL
Enumeration date
11/28/2006
Last updated
08/22/2020
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