Organization Active NPI

Diversicare of Brookhaven, LLC

  • Skilled Nursing Facility
  • Brookhaven, MS
National Provider Identifier
1831644822
Registry record updated Sep 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
377 Issued in MS
Legal business name
DIVERSICARE OF BROOKHAVEN, LLC
Practice address
519 Brookman Dr
Brookhaven, MS 39601-2326
Phone
(601) 833-2881
Fax
(601) 833-2360
NPI assigned
Aug 18, 2016
Organization subpart
Yes
Parent organization
DIVERSICARE LEASING COMPANY III, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 3, 2026

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 & Secretary
Phone
(615) 550-9459

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 377 MS Primary

Addresses

Primary practice location

519 Brookman Dr
Brookhaven, MS 39601-2326

Mailing address

730 Cool Springs Blvd Ste 200
Franklin, TN 37067-7290
Phone (615) 550-9453

Other identifiers 1

IdentifierTypeStateIssuer
00023021MedicaidMS

Other names 1

  • Diversicare of Brookhaven Doing business as

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 42

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 42

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Care Compare: Nursing home

Medicare Care Compare
Listed as
Diversicare of BrookhavenCCN 255175
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Mar 1, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5851.0 residents per day on average
Chain
Diversicare Healthcare44 facilities in the chain
Penalties (3 years)
1Fines totaling $8,788

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0673779Diversicare of Brookhaven, LLC519 Brookman Dr, Brookhaven, MS 39601Certificate of waiverAug 31, 2026

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161108001583 MS Part A Provider - Skilled Nursing Facility 9739468190 Practice locations: Brookhaven, MS

Skilled nursing facility certification: CCN 255175

Legal name
DIVERSICARE OF BROOKHAVEN LLC
Doing business as
DIVERSICARE OF BROOKHAVEN
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 1, 1994
Last certification
Jun 20, 2024
Beds
58
Ownership / control type
Corporation
Multi-facility organization
Diversicare Healthcare Services, LLC
Organization structure
LLCProprietary
Incorporated
Jul 1, 2016 in DE
Enrollment address
519 Brookman Dr
Brookhaven, MS 39601-2326
Nursing home name
DIVERSICARE OF BROOKHAVEN
Affiliated entity
DIVERSICARE HEALTHCARE

All disclosed owners & managing parties 15

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Charolett Canova Individual Operational/Managerial Control Oct 4, 2017
Adp of the SNF Oct 4, 2017
Franklin Scott Kellman Individual Corporate DirectorBoard Member Sep 13, 2024
Stephen Michael Nee Individual Corporate OfficerChief Executive Officer Feb 20, 2023
Diversicare Management Services LP. Organization, Brentwood, TN Management services company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 1, 2016 100%
Operational/Managerial Control Nov 14, 2024
Eran Ratner Individual Corporate OfficerPresident Sep 13, 2024
Corporate DirectorBoard Member Nov 19, 2021
Matthew J Weishaar Individual Corporate OfficerCfo and Secretary Dec 1, 2003
Diversicare Healthcare Services LLC Organization, Brentwood, TN LLC, For-profit, Chain home office, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 4, 2022 99%
Dac Acquisition LLC Organization, Lynbrook, NY LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Nov 19, 2021 100%
Brian Kohn Individual Corporate DirectorBoard Member Nov 19, 2021
Cole T Hodges Individual Operational/Managerial Control Nov 15, 2024
Adp of the SNF Nov 15, 2024
Dac Newcorp Inc Organization, Brentwood, TN Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 4, 2022 100%
Rebecca B Bodie Individual Corporate OfficerEvp and Chief Operating Officer Mar 2, 2020
Diversicare Leasing Company III LLC Organization, Brentwood, TN Created for acquisition, LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jul 1, 2016 100%
Advocat Finance, LLC Organization, Brentwood, TN LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 1, 2016 100%
Diversicare of Brookhaven LLC Organization, Brookhaven, MS LLC, For-profit Operational/Managerial Control Oct 1, 2016

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1471478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788393600000",
    "number": "1831644822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 COOL SPRINGS BLVD STE 200",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370677290",
            "telephone_number": "615-550-9453",
            "fax_number": "615-915-6935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 BROOKMAN DR",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012326",
            "telephone_number": "601-833-2881",
            "fax_number": "601-833-2360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE OF BROOKHAVEN, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIVERSICARE LEASING COMPANY III, LLC",
        "enumeration_date": "2016-08-18",
        "last_updated": "2026-09-03",
        "certification_date": "2026-09-03",
        "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 & SECRETARY",
        "authorized_official_telephone_number": "615-550-9459"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00023021",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diversicare of Brookhaven",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Diversicare of Brookhaven",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookhaven, MS

Sources for this page

Verify at the official NPI Registry.