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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 Facility4964OH

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 : 1780672873
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIVERSICARE LEASING LP
Provider Business Mailing Address
First Line : 2159 DOGWOOD RIDGE RD
Second Line :
City : WHEELERSBURG
State : OH
Zip : 45694-9044
Country : US
Telephone Number : 740-574-2558
Fax Number : 740-574-5426
Provider Business Practice Location Address
First Line : 2159 DOGWOOD RIDGE RD
Second Line :
City : WHEELERSBURG
State : OH
Zip : 45694-9044
Country : US
Telephone Number : 740-574-2558
Fax Number : 740-574-5426
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER/SECRETARY
Name : MATTHEW J. WEISHAAR
Credential :
Telephone Number : 615-550-9459
Provider Enumeration Date : 10/12/2005
Last Update Date : 01/20/2023

Similar Medicare Providers

1902143241 — NATHAN LEE STEVENS RN
Practice Location Address:
2159 DOGWOOD RIDGE RD
WHEELERSBURG, OH
45694-9044
Practice Phone: 740-574-2558
Practice Fax:
1750774725 — MELVA JEANNE GORDON NURSE PRACTITIONER
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Practice Fax:
1396245783 — ANGELA F DUHL
Practice Location Address:
2159 DOGWOOD RIDGE RD
WHEELERSBURG, OH
45694-9044
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Practice Fax:
1316448103 — MRS. AMANDA RENEE MEEKER OTR/L
Practice Location Address:
2159 DOGWOOD RIDGE RD
WHEELERSBURG, OH
45694-9044
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Practice Fax:
1649744384 — AMANDA L GILLENWATER APRN-CNP
Practice Location Address:
2159 DOGWOOD RIDGE RD
WHEELERSBURG, OH
45694-9044
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Practice Fax:
1528655669 — LEANN CAROL MARQUEZ FNP
Practice Location Address:
2159 DOGWOOD RIDGE RD
WHEELERSBURG, OH
45694-9044
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Practice Fax:

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