Diversicare of Colorado Springs, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

DIVERSICARE OF COLORADO SPRINGS, LLC

Doing business as

Diversicare of Colorado Springs

Practice address

110 W Van Buren St
Colorado Springs, CO 80907-6713

Phone

(719) 475-8686

Fax

(615) 620-7875

NPI assigned

May 23, 2015

Last updated

May 23, 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 & Ceo

Phone

(615) 771-7575

Specialties & licenses 1

Addresses

Other names 1

• Diversicare of Colorado Springs 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": "1306225362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 W VAN BUREN ST",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809076713",
            "telephone_number": "719-475-8686",
            "fax_number": "615-620-7875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W VAN BUREN ST",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809076713",
            "telephone_number": "719-475-8686",
            "fax_number": "615-620-7875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE OF COLORADO SPRINGS, 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 Colorado Springs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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.