1518086420 NPI number — DIAMOND LIFE HEALTH CARE, 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 1518086420 NPI number — DIAMOND LIFE HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAMOND LIFE HEALTH CARE, 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:
1518086420
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:
PO BOX 820
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEZUMA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50171-0820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-623-5715
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4912 BARNES CITY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEZUMA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50171-8544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-623-5715
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COON
Authorized Official First Name:
CLOIS
Authorized Official Middle Name:
LUTHER
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
402-426-5150

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  R-725 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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