Diversicare Leasing Corp.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

540 Issued in AR

Legal business name

DIVERSICARE LEASING CORP.

Doing business as

Ouachita Nursing and Rehabilitation Center

Practice address

1411 Country Club Rd
Camden, AR 71701-4507

Phone

(870) 836-4111

Fax

(870) 836-5671

NPI assigned

Oct 8, 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

• Ouachita Nursing and Rehabilitation Center Doing business as

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

{
    "created_epoch": "1128729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760470348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 COUNTRY CLUB RD",
            "city": "CAMDEN",
            "state": "AR",
            "postal_code": "717014507",
            "telephone_number": "870-836-4111",
            "fax_number": "870-836-5671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 COUNTRY CLUB RD",
            "city": "CAMDEN",
            "state": "AR",
            "postal_code": "717014507",
            "telephone_number": "870-836-4111",
            "fax_number": "870-836-5671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE LEASING CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-08",
        "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": "AR",
            "license": "540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ouachita Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• William D Dedman, MD
• Velma Defee, BS
• Dawn Deffenbaugh
• Amy Deluca, MD
• Fred W Dietrich, D.D.S.
• Al Gregory Dodds, LPC
• Kiley Jane Doherty
• Caitlin Dolive
• Anita Elaine Dorey
• Katie Dowell, APRN FNP

• Skilled Nursing Facility in Camden, AR
• Providers in Camden, AR by specialty
• Skilled Nursing Facility in Arkansas

• 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.