Provider Demographics
NPI:1902968324
Name:DIVERSIFIED HEALTH SERVICES INC
Entity Type:Organization
Organization Name:DIVERSIFIED HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAGNOLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-253-8238
Mailing Address - Street 1:948 CAMBRIDGE DR
Mailing Address - Street 2:SUITE 103 A
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:948 CAMBRIDGE DR
Practice Address - Street 2:SUITE 103 A
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3646
Practice Address - Country:US
Practice Address - Phone:504-253-8238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA348251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1402621Medicaid
LA197273Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER