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General NPI Number Information
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NPI Number | 1821408394
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Entity Type | Organization
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Legal Business Name | DIVERSICARE OF NICHOLASVILLE, LLC
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 100 SPARKS AVE
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-1004
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Country | US
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Telephone | 859-885-4171
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Fax | 615-620-7875
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Provider Business Mailing Address
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Address Line | 100 SPARKS AVE
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-1004
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Country | US
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Telephone | 859-885-4171
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Fax | 615-620-7875
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | KELLY J GILL
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Credential |
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Telephone | 615-771-7575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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