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NPI Code Detail

MEDICARE: DIVERSICARE LEASING LP

MEDICARE: DIVERSICARE LEASING LP
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
1314000000XSkilled Nursing Facility0000000306TN

Other Identifiers

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

General Provider Information

NPI Number : 1548258676
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIVERSICARE LEASING LP
Provider Business Mailing Address
First Line : 537 SPRING ST
Second Line :
City : DOVER
State : TN
Zip : 37058-3232
Country : US
Telephone Number : 931-232-6902
Fax Number : 931-232-4256
Provider Business Practice Location Address
First Line : 537 SPRING ST
Second Line :
City : DOVER
State : TN
Zip : 37058-3232
Country : US
Telephone Number : 931-232-6902
Fax Number : 931-232-4256
Authorized Official
Title or Position : CFO/SECRETARY
Name : MATTHEW J. WEISHAAR
Credential :
Telephone Number : 615-550-9459
Provider Enumeration Date : 10/12/2005
Last Update Date : 01/19/2023

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Directions to “DIVERSICARE LEASING LP ” Practice Location

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