Healthcare Provider Details

I. General information

NPI: 1750760716
Provider Name (Legal Business Name): DIVERSICARE OF WORLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2015
Last Update Date: 05/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 HOWELL AVE
WORLAND WY
82401-3733
US

IV. Provider business mailing address

1901 HOWELL AVE
WORLAND WY
82401-3733
US

V. Phone/Fax

Practice location:
  • Phone: 307-347-4285
  • Fax: 615-620-7875
Mailing address:
  • Phone: 307-347-4285
  • Fax: 615-620-7875

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