Diversicare of Greenville, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

DIVERSICARE OF GREENVILLE, LLC

Doing business as

Diversicare of Greenville

Practice address

521 Greene Dr
Greenville, KY 42345-1409

Phone

(270) 338-1523

Fax

(615) 620-7875

NPI assigned

Aug 22, 2014

Last updated

Oct 21, 2015By the provider in NPPES

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 and Ceo

Phone

(615) 771-7575

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Diversicare of Greenville Doing business as

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

{
    "created_epoch": "1408665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445385600000",
    "number": "1184024424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 GREENE DR",
            "city": "GREENVILLE",
            "state": "KY",
            "postal_code": "423451409",
            "telephone_number": "270-338-1523",
            "fax_number": "615-620-7875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 GREENE DR",
            "city": "GREENVILLE",
            "state": "KY",
            "postal_code": "423451409",
            "telephone_number": "270-338-1523",
            "fax_number": "615-620-7875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE OF GREENVILLE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIVERSICARE LEASING COMPANY II, LLC",
        "enumeration_date": "2014-08-22",
        "last_updated": "2015-10-21",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100364170",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diversicare of Greenville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katharine S Cox, MD
• Dagamac Enterprises LLC (New Horizons Counseling/Broken Wings Pgm)
• De' Andra Destheenia Davis, M.D.
• Kari Melissa Dechenne, M.D.
• Emily Diaz
• Allison Ducoff
• Lisa Kaa Dukes, MSN,ARNP
• Melissa Dukes
• Donna Marillyn Dunlap, PTA
• Mary Cordellia Dwyer, APRN- BC

• Skilled Nursing Facility in Greenville, KY
• Providers in Greenville, 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 Oct 21, 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.