NPIMap

Organization Active NPI

Dac of Shelby, LLC

Doing business as Diversicare of Shelby

  • Skilled Nursing Facility
  • Shelby, MS
National Provider Identifier
1497405328
Registry record updated Sep 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
DAC OF SHELBY, LLC
Doing business as
Diversicare of Shelby
Practice address
1108 Church St
Shelby, MS 38774-2200
Phone
(662) 846-2590
Fax
(662) 398-7766
NPI assigned
Mar 24, 2022
Last updated
Sep 4, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
DAC ACQUISITION LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 4, 2026

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) 550-9459

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

1108 Church St
Shelby, MS 38774-2200

Mailing address

730 Cool Springs Blvd Ste 200
Franklin, TN 37067-7290
Phone (615) 550-9453

Other identifiers 1

IdentifierTypeStateIssuer
00230112MedicaidMS

Other names 1

  • Diversicare of Shelby Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220504001299 MS Part A Provider - Skilled Nursing Facility 9537556923 Practice locations: Shelby, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497405328. Details of each certification follow.

Skilled nursing facility certification: CCN 255293

Legal name
DAC OF SHELBY, LLC
Doing business as
DIVERSICARE OF SHELBY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 2003
Last certification
May 22, 2024
Beds
60
Ownership / control type
Corporation
Organization structure
LLCProprietary
Incorporated
Jan 27, 2022 in DE
Enrollment address
1108 Church St
Shelby, MS 38774-2200
Nursing home name
DIVERSICARE OF SHELBY
Affiliated entity
DIVERSICARE HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Diversicare of ShelbyCCN 255293 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jan 1, 2003
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6056.8 residents per day on average
Chain
Diversicare Healthcare44 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0669514Diversicare of Shelby1108 Church Street, Shelby, MS 38774Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Stephen Michael Nee Individual Corporate OfficerChief Executive Officer Feb 20, 2023
Eran Ratner Individual Corporate OfficerPresident Sep 13, 2024
Corporate DirectorBoard Member Apr 1, 2022
Matthew J Weishaar Individual Corporate OfficerSecretary of Dac Opco LLC Apr 1, 2022
Dac Acquisition LLC Organization, Lynbrook, NY LLC, For-profit 5% Or Greater Indirect Ownership Interest Jan 12, 2022 100%
Dac Opco Mississippi LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Direct Ownership Interest Apr 1, 2022 100%
Brian Kohn Individual Corporate OfficerSecretary Sep 13, 2024
Dac Opco, LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Indirect Ownership Interest Jan 27, 2022 61%
Zina Christian Individual W-2 Managing Employee Apr 1, 2022
Adp of the SNF Jan 6, 2025
Rebecca B Bodie Individual Corporate OfficerChief Operating Officer Apr 1, 2022

Facilities with the same owner 39

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 39

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1648080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788480000000",
    "number": "1497405328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 COOL SPRINGS BLVD STE 200",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370677290",
            "telephone_number": "615-550-9453",
            "fax_number": "615-915-6935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 CHURCH ST",
            "city": "SHELBY",
            "state": "MS",
            "postal_code": "387742200",
            "telephone_number": "662-846-2590",
            "fax_number": "662-398-7766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAC OF SHELBY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAC ACQUISITION LLC",
        "enumeration_date": "2022-03-24",
        "last_updated": "2026-09-04",
        "certification_date": "2026-09-04",
        "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": "615-550-9459"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00230112",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diversicare of Shelby",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Diversicare of Shelby",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelby, MS

Sources for this page

Verify at the official NPI Registry.