Diversicare Leasing Corp.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

534 Issued in AR

Legal business name

DIVERSICARE LEASING CORP.

Doing business as

Conway Healthcare and Rehabilitation Center

Practice address

2603 Dave Ward Dr
Conway, AR 72034-6771

Phone

(501) 329-2149

Fax

(501) 329-4916

NPI assigned

Oct 7, 2005

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 names 1

• Conway Healthcare and Rehabilitation Center Doing business as

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

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104814771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2603 DAVE WARD DR",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720346771",
            "telephone_number": "501-329-2149",
            "fax_number": "501-329-4916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2603 DAVE WARD DR",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720346771",
            "telephone_number": "501-329-2149",
            "fax_number": "501-329-4916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE LEASING CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-07",
        "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": "AR",
            "license": "534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Conway Healthcare and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laura J Dill, APRN
• Brandi Dingler, PHARMD
• Emily Dippel
• Roderick Dison, RECOVERY ASSISTANT
• Keri Ditto
• Haley Danae Dixon
• Jakyra Dixon
• Lakisha K Dixon, PLMSW
• Mikala Dixon
• Miranda L Dixon

• Skilled Nursing Facility in Conway, AR
• Providers in Conway, AR by specialty
• Skilled Nursing Facility in Arkansas

• 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.