NPIMap

Organization Active NPI

Diversicare Leasing Corp.

Doing business as Yorktown Nursing & Rehabilitation Center

  • Skilled Nursing Facility
  • Yorktown, TX
National Provider Identifier
1407845068
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
114687 Issued in TX
Legal business name
DIVERSICARE LEASING CORP.
Doing business as
Yorktown Nursing & Rehabilitation Center
Practice address
670 W 4TH St
Yorktown, TX 78164-5092
Phone
(361) 564-2275
Fax
(361) 564-3593
NPI assigned
Oct 17, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Raymond L. Tyler Jr.
Title
Executive Vice President and Coo
Phone
(615) 771-7575

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 114687 TX Primary

Addresses

Primary practice location

670 W 4TH St
Yorktown, TX 78164-5092

Mailing address

670 W 4TH St
Yorktown, TX 78164-5092
Phone (361) 564-2275

Other identifiers 1

IdentifierTypeStateIssuer
4759MedicaidTX

Other names 1

  • Yorktown Nursing & Rehabilitation Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Diversicare Leasing Corp5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407845068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 W 4TH ST",
            "city": "YORKTOWN",
            "state": "TX",
            "postal_code": "781645092",
            "telephone_number": "361-564-2275",
            "fax_number": "361-564-3593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 W 4TH ST",
            "city": "YORKTOWN",
            "state": "TX",
            "postal_code": "781645092",
            "telephone_number": "361-564-2275",
            "fax_number": "361-564-3593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE LEASING CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TYLER",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT AND COO",
        "authorized_official_telephone_number": "615-771-7575",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "114687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4759",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Yorktown Nursing & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yorktown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.