NPIMap

Organization Active NPI

Diversity Home Care Services LLC

  • Home Health Agency
  • Lathrup Village, MI
National Provider Identifier
1063741007
Registry record updated Jan 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
DIVERSITY HOME CARE SERVICES LLC
Practice address
27208 Southfield Rd
7
Lathrup Village, MI 48076-7912
Phone
(248) 483-9220
Fax
(248) 483-9221
NPI assigned
Dec 22, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Marek Jozef Gaul, RPT
Title
Administrator
Phone
(248) 483-9220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

27208 Southfield Rd
7
Lathrup Village, MI 48076-7912

Mailing address

27208 Southfield Rd
7
Lathrup Village, MI 48076-7912
Phone (248) 483-9220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100318000691 MI Part A Provider - Home Health Agency 5092840801 Practice locations: Dearborn, MI

Home health agency certification: CCN 239173

Legal name
DIVERSITY HOME CARE SERVICES LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 31, 2011
Last certification
Jul 1, 2014
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Oct 9, 2009 in MI
Enrollment address
1213 Mason St
Ste 5
Dearborn, MI 48124-2841

Care Compare: Home health agency

Medicare Care Compare
Listed as
Diversity Home Care Services, LLCCCN 239173
Overall star rating
4 of 5
Ownership
Proprietary
Certified
May 31, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

2021 Monroe St
Ste 104
Dearborn, MI 48124
Phone (248) 483-9220

1213 Mason St
Ste 5
Dearborn, MI 48124
Phone (248) 483-9220

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Marek Gaul Individual 5% Or Greater Direct Ownership InterestDirector/Board Member Oct 13, 2009 50%
General Partnership InterestAdministrator Oct 13, 2009 50%
W-2 Managing EmployeeDirector Oct 13, 2009 50%
Caigl Chambers Individual W-2 Managing EmployeeDirector of Nursing Jan 1, 2012 25%
Deanna Jaszczur Individual 5% Or Greater Direct Ownership Interest Jul 4, 1970 50%
General Partnership InterestDirector-Board Member Oct 13, 2009 50%
Corporate DirectorBoard Member Jul 4, 1970 25%
W-2 Managing EmployeeAdministrator/Director Oct 13, 2009 50%

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1261440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326153600000",
    "number": "1063741007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27208 SOUTHFIELD RD",
            "address_2": "7",
            "city": "LATHRUP VILLAGE",
            "state": "MI",
            "postal_code": "480767912",
            "telephone_number": "248-483-9220",
            "fax_number": "248-483-9221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27208 SOUTHFIELD RD",
            "address_2": "7",
            "city": "LATHRUP VILLAGE",
            "state": "MI",
            "postal_code": "480767912",
            "telephone_number": "248-483-9220",
            "fax_number": "248-483-9221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSITY HOME CARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-22",
        "last_updated": "2012-01-10",
        "status": "A",
        "authorized_official_last_name": "GAUL",
        "authorized_official_first_name": "MAREK",
        "authorized_official_middle_name": "JOZEF",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "248-483-9220",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lathrup Village, MI

Sources for this page

Verify at the official NPI Registry.