Diversicare Leasing LP

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

N4907 Issued in AL

Legal business name

DIVERSICARE LEASING LP

Doing business as

Lynwood Nursing Home

Practice address

4164 Halls Mill Rd
Mobile, AL 36693-5614

Phone

(251) 661-5404

Fax

(251) 661-5407

NPI assigned

Oct 5, 2005

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 Jr.

Title

Cfo/Secretary

Phone

(615) 550-9459

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lynwood Nursing Home Doing business as

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674086400000",
    "number": "1386631182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4164 HALLS MILL RD",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366935614",
            "telephone_number": "251-661-5404",
            "fax_number": "251-661-5407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4164 HALLS MILL RD",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366935614",
            "telephone_number": "251-661-5404",
            "fax_number": "251-661-5407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE LEASING LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A",
        "authorized_official_last_name": "WEISHAAR",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CFO/SECRETARY",
        "authorized_official_telephone_number": "615-550-9459",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AL",
            "license": "N4907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47-54270S",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lynwood Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lynwood Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Mobile, AL
• Providers in Mobile, 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 Jan 19, 2023; 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.