Diversicare Leasing LP

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

N5704 Issued in AL

Legal business name

DIVERSICARE LEASING LP

Doing business as

Canterbury Healthcare Facility

Practice address

1720 Knowles Rd
Phenix City, AL 36869-7135

Phone

(334) 291-0486

Fax

(334) 297-5816

NPI assigned

Oct 1, 2005

Last updated

Oct 25, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew J. Weishaar

Title

Chief Financial Officer & Secretary

Phone

(615) 771-7575

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Canterbury Healthcare Facility Doing business as

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

{
    "created_epoch": "1128124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666656000000",
    "number": "1306833694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 KNOWLES RD",
            "city": "PHENIX CITY",
            "state": "AL",
            "postal_code": "368697135",
            "telephone_number": "334-291-0486",
            "fax_number": "334-297-5816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 KNOWLES RD",
            "city": "PHENIX CITY",
            "state": "AL",
            "postal_code": "368697135",
            "telephone_number": "334-291-0486",
            "fax_number": "334-297-5816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE LEASING LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-01",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A",
        "authorized_official_last_name": "WEISHAAR",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER & SECRETARY",
        "authorized_official_telephone_number": "615-771-7575"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AL",
            "license": "N5704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47-57740S",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canterbury Healthcare Facility",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Canterbury Healthcare Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Phenix City, AL
• Providers in Phenix City, AL by specialty
• Skilled Nursing Facility in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; 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.