Diversicare Leasing Corp.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

100156 Issued in KY

Legal business name

DIVERSICARE LEASING CORP.

Doing business as

South Shore Nursing & Rehabilitation Center

Practice address

489 James Hannah Drive
South Shore, KY 41175-0489

Phone

(606) 932-3127

Fax

(606) 932-4663

NPI assigned

Oct 11, 2005

Last updated

Aug 22, 2020By 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

Raymond L. Tyler Jr.

Title

Executive Vice President and Coo

Phone

(615) 771-7575

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• South Shore Nursing & Rehabilitation Center Doing business as

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477541688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 489",
            "address_2": "JAMES HANNAH DRIVE",
            "city": "SOUTH SHORE",
            "state": "KY",
            "postal_code": "411750489",
            "telephone_number": "606-932-3127",
            "fax_number": "606-932-4663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 JAMES HANNAH DRIVE",
            "city": "SOUTH SHORE",
            "state": "KY",
            "postal_code": "411750489",
            "telephone_number": "606-932-3127",
            "fax_number": "606-932-4663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE LEASING CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "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": "KY",
            "license": "100156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12503025",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Shore Nursing & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in South Shore, KY
• Providers in South Shore, KY by specialty
• Skilled Nursing Facility in Kentucky

• 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.