Healthcare Provider Details

I. General information

NPI: 1952736779
Provider Name (Legal Business Name): DIVERSICARE OF SIENA WOODS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 N MAIN ST
DAYTON OH
45415-3110
US

IV. Provider business mailing address

6125 N MAIN ST
DAYTON OH
45415-3110
US

V. Phone/Fax

Practice location:
  • Phone: 937-278-8211
  • Fax: 937-278-8046
Mailing address:
  • Phone: 937-278-8211
  • Fax: 937-278-8046

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 & CEO
Credential:
Phone: 615-771-7575