1184649915 NPI number — DIYAH'S HOME INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184649915 NPI number — DIYAH'S HOME INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIYAH'S HOME INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184649915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
295 APPALOOSA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING LAKE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28390-8503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-497-8599
Provider Business Mailing Address Fax Number:
910-436-5928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
295 APPALOOSA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING LAKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28390-8503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-497-8599
Provider Business Practice Location Address Fax Number:
910-436-5928
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAQQ
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
OMAR
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
910-978-8599

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  MHL-026-583 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X , with the licence number: MHL-043-056 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320600000X , with the licence number: MHL-043-045 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6603270 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603854 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603538 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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