Diamond State Mobility LLC

Primary specialty

Home Modifications ContractorTaxonomy code 171WH0202X

License

6421913 Issued in PA

Legal business name

DIAMOND STATE MOBILITY LLC

Practice address

602 Market St
Marcus Hook, PA 19061-4719

Phone

(215) 908-3239

NPI assigned

Jun 22, 2016

Organization subpart

No

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

Authorized official

Name

Teal A Connell

Title

Owner

Phone

(302) 559-5652

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1466553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466553600000",
    "number": "1538510367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 MARKET ST",
            "city": "MARCUS HOOK",
            "state": "PA",
            "postal_code": "190614719",
            "telephone_number": "215-908-3239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 MARKET ST",
            "city": "MARCUS HOOK",
            "state": "PA",
            "postal_code": "190614719",
            "telephone_number": "215-908-3239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAMOND STATE MOBILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-22",
        "last_updated": "2016-06-22",
        "status": "A",
        "authorized_official_last_name": "CONNELL",
        "authorized_official_first_name": "TEAL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "302-559-5652"
    },
    "taxonomies": [
        {
            "code": "171WH0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Contractor, Home Modifications",
            "state": "PA",
            "license": "6421913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Advanced Care Centers of Pennsylvania, Inc.
• Anthony Sniechoski
• Basic DME
• Tyree Brabham Sr.
• Vanessa Clark, MFT, LPC
• Shakeena Ferrell
• Dawn Sherri Fortuna, PTA
• Paul Andrew Frumento, DPM
• Samantha Garofalo, OT
• Health Access Network

• Home Modifications Contractor in Marcus Hook, PA
• Providers in Marcus Hook, PA by specialty
• Home Modifications Contractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2016; 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.