Provider Demographics
NPI:1144804519
Name:DIAMOND DIVA EMPOWERMENT FOUNDATION INITIATIVE 2DEF
Entity type:Organization
Organization Name:DIAMOND DIVA EMPOWERMENT FOUNDATION INITIATIVE 2DEF
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-328-4348
Mailing Address - Street 1:1027 S VANDEVENTER AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3854
Mailing Address - Country:US
Mailing Address - Phone:314-328-4348
Mailing Address - Fax:
Practice Address - Street 1:1027 S VANDEVENTER AVE FL 6
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-3854
Practice Address - Country:US
Practice Address - Phone:314-328-4348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management