Diversicare of Riverside, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

042401 Issued in MO

Legal business name

DIVERSICARE OF RIVERSIDE, LLC

Practice address

1616 Weisenborn Rd
Saint Joseph, MO 64507-2527

Phone

(816) 232-9874

Fax

(816) 364-4283

NPI assigned

Jun 22, 2014

Organization subpart

Yes

Parent organization

DIVERSICARE LEASING COMPANY II, LLCAs reported in NPPES

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

Phone

(615) 771-7575

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Riverside Place Doing business as

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

{
    "created_epoch": "1403395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680825600000",
    "number": "1669887352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 WEISENBORN RD",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645072527",
            "telephone_number": "816-232-9874",
            "fax_number": "816-364-4283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 WEISENBORN RD",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645072527",
            "telephone_number": "816-232-9874",
            "fax_number": "816-364-4283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE OF RIVERSIDE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIVERSICARE LEASING COMPANY II, LLC",
        "enumeration_date": "2014-06-22",
        "last_updated": "2023-04-07",
        "certification_date": "2023-04-07",
        "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",
        "authorized_official_telephone_number": "615-771-7575"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MO",
            "license": "042402",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "042401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669887352",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Place",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Riverside Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elena Dimiceli, M.D.
• Frederick Dimmel III, CRNA
• Kylie Dishman
• Kaley Irene Dittemore
• Diversicare of Chateau LLC
• Diversicare of St. Joseph, LLC
• Alexa Dixon
• Charles W Dobbs, MD
• Dennis Charles Dobyan, MD
• Caleb Paul Dodd

• Skilled Nursing Facility in Saint Joseph, MO
• Providers in Saint Joseph, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.