Healthcare Provider Details

I. General information

NPI: 1235326349
Provider Name (Legal Business Name): DIVERSICARE PARIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 08/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2885 STILLHOUSE RD
PARIS TX
75462-2042
US

IV. Provider business mailing address

2885 STILLHOUSE RD
PARIS TX
75462-2042
US

V. Phone/Fax

Practice location:
  • Phone: 903-784-4111
  • Fax: 903-784-7121
Mailing address:
  • Phone: 903-784-4111
  • Fax: 903-784-7121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number127763
License Number StateTX

VIII. Authorized Official

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