Provider Demographics
NPI:1144907429
Name:DIVERSITY HEALTHCARE 'LLC'
Entity type:Organization
Organization Name:DIVERSITY HEALTHCARE 'LLC'
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:REEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN-C
Authorized Official - Phone:863-419-4422
Mailing Address - Street 1:1011 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:FL
Mailing Address - Zip Code:33844
Mailing Address - Country:US
Mailing Address - Phone:863-419-4422
Mailing Address - Fax:833-795-1975
Practice Address - Street 1:1011 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAINES
Practice Address - State:FL
Practice Address - Zip Code:33844
Practice Address - Country:US
Practice Address - Phone:863-419-4422
Practice Address - Fax:833-795-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty