Provider Demographics
NPI:1861956211
Name:DILIGENT SERVICE PROVIDERS LLC
Entity type:Organization
Organization Name:DILIGENT SERVICE PROVIDERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:HORATIO
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:I
Authorized Official - Credentials:CNA
Authorized Official - Phone:860-712-0831
Mailing Address - Street 1:110 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2818
Mailing Address - Country:US
Mailing Address - Phone:860-712-0831
Mailing Address - Fax:888-977-3102
Practice Address - Street 1:110 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051
Practice Address - Country:US
Practice Address - Phone:860-712-0831
Practice Address - Fax:888-977-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1700328010Medicaid