Diversicare Leasing Corp.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

100571 Issued in KY

Legal business name

DIVERSICARE LEASING CORP.

Doing business as

Carter Nursing & Rehabilitation Center

Practice address

250 McDavid Blvd
Grayson, KY 41143-1603

Phone

(606) 474-7835

Fax

(606) 474-8114

NPI assigned

Oct 11, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Raymond L. Tyler Jr.

Title

Executive Vice President and Coo

Phone

(615) 771-7575

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Carter Nursing & Rehabilitation Center Doing business as

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093703308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 MCDAVID BLVD",
            "city": "GRAYSON",
            "state": "KY",
            "postal_code": "411431603",
            "telephone_number": "606-474-7835",
            "fax_number": "606-474-8114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 MCDAVID BLVD",
            "city": "GRAYSON",
            "state": "KY",
            "postal_code": "411431603",
            "telephone_number": "606-474-7835",
            "fax_number": "606-474-8114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE LEASING CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TYLER",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT AND COO",
        "authorized_official_telephone_number": "615-771-7575",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "KY",
            "license": "100571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12503132",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carter Nursing & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeffrey Joseph Curley, ATC
• Nathan Curnutte, PHARMD
• Jessica Dale, DPT
• Tommy Dearfield Jr., PHARM. D
• Barbara Dickerson
• Tara Nicole Dollar, PA-C
• Meagan Rhea Doyle, MD
• Christopher Dunn, OTR/L
• Emily Dyer
• Kristy Danielle Dyer, PT

• Skilled Nursing Facility in Grayson, KY
• Providers in Grayson, KY by specialty
• Skilled Nursing Facility in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.