Provider Demographics
NPI:1538223672
Name:DIVERSIFIED RESOURCES, INC.
Entity type:Organization
Organization Name:DIVERSIFIED RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:YARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-285-3089
Mailing Address - Street 1:PO BOX 1099
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-1099
Mailing Address - Country:US
Mailing Address - Phone:912-285-3089
Mailing Address - Fax:912-285-0367
Practice Address - Street 1:147 KNIGHT AVE CIR
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503
Practice Address - Country:US
Practice Address - Phone:912-285-3089
Practice Address - Fax:912-205-0367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty