MEDICARE: DIVERSICARE LEASING CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	100156	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477541688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSICARE LEASING CORP.

Provider Business Mailing Address
First Line	:	PO BOX 489
Second Line	:	JAMES HANNAH DRIVE
City	:	SOUTH SHORE
State	:	KY
Zip	:	41175-0489
Country	:	US
Telephone Number	:	606-932-3127
Fax Number	:	606-932-4663

Provider Business Practice Location Address
First Line	:	489 JAMES HANNAH DRIVE
Second Line	:
City	:	SOUTH SHORE
State	:	KY
Zip	:	41175-0489
Country	:	US
Telephone Number	:	606-932-3127
Fax Number	:	606-932-4663

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT AND COO
Name	:	RAYMOND L. TYLER JR.
Credential	:
Telephone Number	:	615-771-7575

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	08/22/2020

Similar Medicare Providers

1457427296 — DR. JOSEPH DAVID COHN JR. DDS
Practice Location Address:

121 SOUTH BOHEMIA AVENUE
CECILTON, MD
21913-0489

Practice Phone: 410-275-2225
Practice Fax: 410-275-2423

1598613317 — HILLARY SUE BOWLING
Practice Location Address:

94 WAYNE RD
SOUTH SHORE, KY
41175-8463

Practice Phone: 606-694-5923
Practice Fax:

1245234277 — MR. GREGORY HUDSON MD
Practice Location Address:

137 STATE ROUTE 3117
SOUTH SHORE, KY
41175-9597

Practice Phone: 606-932-2079
Practice Fax: 606-932-2313

1811964323 — DR. FORREST ELMER MONOSKIE DC
Practice Location Address:

U.S .23 & 39 MILDRED AVE
SOUTH SHORE, KY
41175-0767

Practice Phone: 606-932-3033
Practice Fax: 606-932-9335

1083652515 — MS. CHRISTINE PICKELSIMER
Practice Location Address:

29 CONEY ISLAND DR
SOUTH SHORE, KY
41175-9020

Practice Phone: 606-932-6203
Practice Fax:

1730122680 — JAMES YOUNT PA
Practice Location Address:

142 DEPOT DRIVE
SOUTH SHORE, KY
41175

Practice Phone: 606-932-2271
Practice Fax: 606-932-2273

Directions to “DIVERSICARE LEASING CORP. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.