Diversicare Estates LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

114048 Issued in TX

Legal business name

DIVERSICARE ESTATES LLC

Doing business as

Estates Healthcare and Rehabilitation Center

Practice address

201 Sycamore School Rd
Fort Worth, TX 76134-5009

Phone

(817) 293-7610

Fax

(817) 293-5766

NPI assigned

Jul 19, 2007

Last updated

Aug 4, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

ADVOCAT INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly J Gill

Title

President and Ceo

Phone

(615) 771-7575

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Estates Healthcare and Rehabilitation Center Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Diversicare Leasing LP

  dba Diversicare of Martin

  • Skilled Nursing Facility
  • Martin, TN
  • NPI 1538157664

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344038400000",
    "number": "1053511998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 SYCAMORE SCHOOL RD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761345009",
            "telephone_number": "817-293-7610",
            "fax_number": "817-293-5766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SYCAMORE SCHOOL RD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761345009",
            "telephone_number": "817-293-7610",
            "fax_number": "817-293-5766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE ESTATES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVOCAT INC.",
        "enumeration_date": "2007-07-19",
        "last_updated": "2012-08-04",
        "status": "A",
        "authorized_official_last_name": "GILL",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "615-771-7575"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "114048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE SNF",
            "identifier": "67-5028",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Estates Healthcare and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joanne Dispo, APRN-PMHNP
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• William Ira Dittman, M.D.
• Richard Keith Ditto, O.D.
• Thomas E Diver, PA
• Divine Home Health Care Services
• Shelby Paige Diviney, SLP
• Divinity Hospice, LLC (Divinity Healthcare)
• Dixon Chiropractic, LLC (Evolve Chiropractic)
• Verlisa Dixon-Green

• Skilled Nursing Facility in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.