Diversicare Rose Terrace, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

183 Issued in WV

Legal business name

DIVERSICARE ROSE TERRACE, LLC

Doing business as

Rose Terrace Health and Rehabilitation Center

Practice address

30 Hidden Brook Way
Culloden, WV 25510

Phone

(615) 771-7575

Fax

(615) 620-7875

NPI assigned

Apr 29, 2011

Last updated

Nov 14, 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 2

Other names 1

• Rose Terrace Health 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": "1304035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352851200000",
    "number": "1104117761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 HIDDEN BROOK WAY",
            "city": "CULLODEN",
            "state": "WV",
            "postal_code": "25510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 HIDDEN BROOK WAY",
            "city": "CULLODEN",
            "state": "WV",
            "postal_code": "25510",
            "telephone_number": "615-771-7575",
            "fax_number": "615-620-7875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE ROSE TERRACE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVOCAT INC.",
        "enumeration_date": "2011-04-29",
        "last_updated": "2012-11-14",
        "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": "WV",
            "license": "183",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE SNF",
            "identifier": "51-5192",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810023465",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rose Terrace Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Josephine Clark
• Maggie Collins
• Tammy Collins
• Kari E Cox
• Violet Davis
• Elsie Ann Duncan
• Kimberly Edwards
• Jessica Farley
• Amber Foreman
• Kathryn Ann Fulks

• Skilled Nursing Facility in Culloden, WV
• Providers in Culloden, WV by specialty
• Skilled Nursing Facility in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 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.