Provider Demographics
NPI:1639917875
Name:BLUE DIAMOND HEALTH CARE LLC
Entity type:Organization
Organization Name:BLUE DIAMOND HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TECONNIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-628-5247
Mailing Address - Street 1:2300 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-3829
Mailing Address - Country:US
Mailing Address - Phone:513-628-5247
Mailing Address - Fax:
Practice Address - Street 1:2300 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-3829
Practice Address - Country:US
Practice Address - Phone:513-628-5247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health