Diversicare Leasing Corp.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

100690 Issued in KY

Legal business name

DIVERSICARE LEASING CORP.

Doing business as

Elliott Nursing & Rehabilitation Center

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

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 names 1

• Elliott Nursing & Rehabilitation Center Doing business as

Locations

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720076771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 694",
            "address_2": "RTE 32 E HOWARD CREEK RD",
            "city": "SANDY HOOK",
            "state": "KY",
            "postal_code": "411710694",
            "telephone_number": "606-738-9400",
            "fax_number": "606-738-9410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RTE 32 E HOWARD CREEK RD",
            "city": "SANDY HOOK",
            "state": "KY",
            "postal_code": "41171",
            "telephone_number": "606-738-9400",
            "fax_number": "606-738-9410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE LEASING CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "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": "100690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elliott Nursing & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wayne Colyer
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• John Brett Dickerson
• Discount Drug Mart, Inc
• Dr. Kimberly a. Buckner, P.L.C.
• Carla Dianne Dyer, DNP, APRN
• Kara Elam, RN
• Elliott County Ambulance Service
• Elliott County Health Center

• Skilled Nursing Facility in Sandy Hook, KY
• Providers in Sandy Hook, 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.