Diversicare of Southaven, LLC
Organization Active NPI Skilled Nursing Facility · Southaven, MS
NPI 1801341896 · NPPES record last updated Sep 4, 2026
Key facts
- NPI
- 1801341896
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 388 (MS)
- Legal business name
- DIVERSICARE OF SOUTHAVEN, LLC
- Practice address
- 1730 Dorchester Dr
Southaven, MS 38671-5723 - Phone
- (662) 393-0050
- Fax
- (662) 393-5179
- NPI assigned
- Aug 18, 2016
- Organization subpart
- Yes
- Parent organization (as reported)
- DIVERSICARE LEASING COMPANY III, LLC
Authorized official
- Name
- Matthew J Weishaar
- Title
- Chief Financial Officer & Secretary
- Phone
- (615) 550-9459
Facilities with the same owner 42
Practitioners 3
-
Marimichael Hill Byrd, FNP-C
-
Marketia Morrow, FNP-BC, FNP-C
-
Dana Ann Nash, M.D.
Affiliated clinicians 3
-
Marimichael Hill Byrd, FNP-C
-
Marketia Morrow, FNP-BC, FNP-C
-
Dana Ann Nash, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Diversicare of Southaven
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Apr 1, 1989
- Medicare certification status
- Active
- Certified beds
- 140 · 132.0 residents per day on average
- Chain
- Diversicare Healthcare
- Penalties (3 years)
- 9 · fines totaling $78,295
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D0669929 | Diversicare of Southaven, LLC | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Skilled nursing facility certification: CCN 255109
- Legal name
- DIVERSICARE OF SOUTHAVEN LLC
- Doing business as
- DIVERSICARE OF SOUTHAVEN
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Apr 1, 1989
- Last certification
- Mar 20, 2025
- Beds
- 140
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Diversicare Healthcare Services, LLC
- Organization structure
- LLC · Proprietary
- Incorporated
- Jul 1, 2016 in DE
- Enrollment address
- 1730 Dorchester Dr
Southaven, MS 38671-5723 - Nursing home name
- DIVERSICARE OF SOUTHAVEN
- Affiliated entity
- DIVERSICARE HEALTHCARE
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Franklin Scott Kellman |
Corporate Director |
Sep 13, 2024 | |
| Diversicare of Southaven LLC |
Other | Oct 1, 2016 | |
| Stephen Michael Nee |
Corporate Officer |
Feb 20, 2023 | |
| DMS GP LLC |
General Partnership Interest | Apr 4, 2022 | 1% |
| Diversicare Management Services LP. |
5% Or Greater Indirect Ownership Interest | Jul 1, 2016 | 100% |
| Eran Ratner |
Corporate Officer |
Sep 13, 2024 | |
| Corporate Director |
Nov 19, 2021 | ||
| Operational/Managerial Control |
Sep 13, 2024 | ||
| Matthew J Weishaar |
Corporate Officer |
Dec 1, 2003 | |
| Diversicare Healthcare Services LLC |
5% Or Greater Indirect Ownership Interest | May 10, 1994 | 99% |
| Dac Acquisition LLC |
5% Or Greater Indirect Ownership Interest | Nov 19, 2021 | 100% |
| Brian Kohn |
Corporate Director |
Nov 19, 2021 | |
| Charles Small |
Operational/Managerial Control |
Feb 15, 2024 | |
| Dac Newcorp Inc |
5% Or Greater Indirect Ownership Interest | Apr 4, 2022 | 100% |
| Rebecca B Bodie |
Corporate Officer |
Mar 2, 2020 | |
| Diversicare Leasing Company III LLC |
5% Or Greater Direct Ownership Interest | Jul 1, 2016 | 100% |
| Advocat Finance, LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2016 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161122000006 | MS | Part a Provider - Skilled Nursing Facility | 0941589659 | Practice locations: Southaven, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 388 | MS | Yes |
Addresses
Primary practice location
1730 Dorchester Dr
Southaven, MS 38671-5723
Mailing address
730 Cool Springs Blvd Ste 200
Franklin, TN 37067-7290
Phone (615) 550-9453
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00023137 | Medicaid | MS |
Other names
- Diversicare of Southaven
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All providers in Southaven, MS · Skilled Nursing Facility in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 4, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.