Diversicare of Laramie, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

DIVERSICARE OF LARAMIE, LLC

Practice address

503 S 18TH St
Laramie, WY 82070-4303

Phone

(307) 742-3728

Fax

(615) 620-7875

NPI assigned

May 23, 2015

Organization subpart

Yes

Parent organization

DIVERSICARE LEASING COMPANY II, LLCAs 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 & Ceo

Phone

(615) 771-7575

Specialties & licenses 1

Addresses

Other names 1

• Diversicare of Laramie Doing business as

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

{
    "created_epoch": "1432339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432339200000",
    "number": "1114306172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 S 18TH ST",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820704303",
            "telephone_number": "307-742-3728",
            "fax_number": "615-620-7875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 S 18TH ST",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820704303",
            "telephone_number": "307-742-3728",
            "fax_number": "615-620-7875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE OF LARAMIE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIVERSICARE LEASING COMPANY II, LLC",
        "enumeration_date": "2015-05-23",
        "last_updated": "2015-05-23",
        "status": "A",
        "authorized_official_last_name": "GILL",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "615-771-7575"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diversicare of Laramie",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Terrence J. Dini, D.C.
• Christine Marie Dipompeo, M.D.
• Megan Dirks
• Lacy Ditirro-Feiten
• Rodney Dittberner
• Athena K Dixon
• Garrett W. Dodson
• Heather Ann Dodson, MSW
• Sergio Dominguez
• Darion Donnelly

• All providers in Laramie, WY
• Skilled Nursing Facility in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2015; 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.