Healthcare Provider Details

I. General information

NPI: 1013359694
Provider Name (Legal Business Name): DIVERSICARE OF SENECA PLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3526 DUTCHMANS LN
LOUISVILLE KY
40205-3256
US

IV. Provider business mailing address

3526 DUTCHMANS LN
LOUISVILLE KY
40205-3256
US

V. Phone/Fax

Practice location:
  • Phone: 615-771-7575
  • Fax: 615-771-7409
Mailing address:
  • Phone: 615-771-7575
  • Fax: 615-771-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: KELLY J GILL
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 615-771-7575