Diversicare Leasing Corp.
Organization Active NPI Skilled Nursing Facility · Lockhart, TX
NPI 1376531343 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1376531343
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 115093 (TX)
- Legal business name
- DIVERSICARE LEASING CORP.
- Practice address
- 107 N Medina St
Lockhart, TX 78644-1919 - Phone
- (512) 398-5213
- Fax
- (512) 376-6880
- NPI assigned
- Oct 12, 2005
- Organization subpart
- No
Authorized official
- Name
- Raymond L. Tyler Jr.
- Title
- Executive Vice President and Coo
- Phone
- (615) 771-7575
Corporate family (same tax ID) 4
National Provider Directory
- Tax ID family
- Diversicare Leasing Corp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 115093 | TX | Yes |
Addresses
Primary practice location
107 N Medina St
Lockhart, TX 78644-1919
Mailing address
107 N Medina St
Lockhart, TX 78644-1919
Phone (512) 398-5213
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4891 | Medicaid | TX |
Other names
- Chisolm Trail Nursing & Rehabilitation Center
Other providers in Lockhart, TX
- Vanessa De Leon
- Dorothy A Dean
- Carol Arlene Dettmann
- Dewitt Medical District
- Diversicare Chisolm, LLC
- Haley Dawn Dorsett
- Alexander Dougherty
- Sherrel Downes
- Sarah Catherine Drake
- Melissa Dunbar
All providers in Lockhart, TX · Skilled Nursing Facility in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.