Organization
DIAMOND GROVE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE FILTON (SR VP CFO)
(610) 768-3300
Entity
Organization
Contact information
Practice address
2311 HIGHWAY 15 S, LOUISVILLE, MS 39339-7071
(662) 779-0119
(662) 779-0126
Mailing address
2311 HIGHWAY 15 S, LOUISVILLE, MS 39339-7071
(662) 779-0119
(662) 779-0126
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
32-325
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000020847
BLUE CROSS PROVIDER#
MS
05
—
00220411
—
MS
05
—
00220801
—
MS
Enumeration date
09/23/2006
Last updated
05/11/2011
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