Provider Demographics
NPI:1164455804
Name:DIAMOND E, ICN.
Entity type:Organization
Organization Name:DIAMOND E, ICN.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:C
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:336-279-8814
Mailing Address - Street 1:1205 W BESSEMER AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8442
Mailing Address - Country:US
Mailing Address - Phone:336-279-8814
Mailing Address - Fax:336-279-8424
Practice Address - Street 1:1205 W BESSEMER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8442
Practice Address - Country:US
Practice Address - Phone:336-279-8814
Practice Address - Fax:336-279-8424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408675Medicaid
NC7100370Medicaid
NC6600427Medicaid