Diamond Supported Living Services, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

687831896 68783189 Issued in FL

Legal business name

DIAMOND SUPPORTED LIVING SERVICES, INC.

Practice address

330 Ivy St
Jacksonville, FL 32206-6350

Phone

(904) 307-6844

Fax

(904) 924-1174

NPI assigned

Nov 28, 2006

Organization subpart

No

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

Authorized official

Name

Tazena E. KennedyNPI 1629144712

Title

Chief Executive Officer

Phone

(904) 307-6844

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tazena Kennedy

  • Case Manager/Care Coordinator
  • Jacksonville, FL
  • NPI 1629144712
  NPD (past) Authorized official

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437225513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2678",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322032678",
            "telephone_number": "904-307-6844",
            "fax_number": "904-924-1174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 IVY ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322066350",
            "telephone_number": "904-307-6844",
            "fax_number": "904-924-1174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAMOND SUPPORTED LIVING SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "TAZENA",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "904-307-6844"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "FL",
            "license": "687831896   68783189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "687831896  687831898",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Andi Diamond, PA-C
• Jane Diamond, ARNP
• Chritian Cynthia Enguerra Diana, APRN-BC
• Jennifer Lee Diana, PA-C
• Michael Raymond Diana, PA-C

• Home Health Agency in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Home Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.