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NPI Code Detail

MEDICARE: DIVERSICARE LEASING LP

MEDICARE: DIVERSICARE LEASING LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityN5704AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306833694
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIVERSICARE LEASING LP
Provider Business Mailing Address
First Line : 1720 KNOWLES RD
Second Line :
City : PHENIX CITY
State : AL
Zip : 36869-7135
Country : US
Telephone Number : 334-291-0486
Fax Number : 334-297-5816
Provider Business Practice Location Address
First Line : 1720 KNOWLES RD
Second Line :
City : PHENIX CITY
State : AL
Zip : 36869-7135
Country : US
Telephone Number : 334-291-0486
Fax Number : 334-297-5816
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER & SECRETARY
Name : MATTHEW J. WEISHAAR
Credential :
Telephone Number : 615-771-7575
Provider Enumeration Date : 10/01/2005
Last Update Date : 10/25/2022

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Directions to “DIVERSICARE LEASING LP ” Practice Location

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