Diversicare Leasing Corp.
Organization Active NPI Skilled Nursing Facility · Sandy Hook, KY
NPI 1720076771 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1720076771
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 100690 (KY)
- Legal business name
- DIVERSICARE LEASING CORP.
- Practice address
- Rte 32 E Howard Creek Rd
Sandy Hook, KY 41171 - Phone
- (606) 738-9400
- Fax
- (606) 738-9410
- NPI assigned
- Oct 12, 2005
- Organization subpart
- No
Authorized official
- Name
- Raymond L. Tyler Jr.
- Title
- Executive Vice President and Coo
- Phone
- (615) 771-7575
National Provider Directory
Locations
32 Howards Creek Rd
Sandy Hook, KY 41171
Phone (606) 738-9400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 100690 | KY | Yes |
Addresses
Primary practice location
Rte 32 E Howard Creek Rd
Sandy Hook, KY 41171
Mailing address
PO Box 694
Rte 32 E Howard Creek Rd
Sandy Hook, KY 41171-0694
Phone (606) 738-9400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12503066 | Medicaid | KY |
Other names
- Elliott Nursing & Rehabilitation Center
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- Carla Dianne Dyer
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All providers in Sandy Hook, KY · Skilled Nursing Facility in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.