Diversicare Doctors LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

130500 Issued in TX

Legal business name

DIVERSICARE DOCTORS LLC

Doing business as

Diversicare of Lake Highlands

Practice address

9009 White Rock TRL
Dallas, TX 75238-3347

Phone

(214) 355-3300

Fax

(615) 620-7875

NPI assigned

Jul 19, 2007

Organization subpart

Yes

Parent organization

DIVERSICARE TEXAS I, LLCAs reported in NPPES

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

Phone

(615) 550-9459

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Diversicare of Lake Highlands Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Diversicare Leasing LP

  dba Diversicare of Martin

  • Skilled Nursing Facility
  • Martin, TN
  • NPI 1538157664

  Member Of

  NPD member

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680825600000",
    "number": "1962602805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1621 GALLERIA BLVD",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370272926",
            "telephone_number": "214-771-7575",
            "fax_number": "615-915-6935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9009 WHITE ROCK TRL",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752383347",
            "telephone_number": "214-355-3300",
            "fax_number": "615-620-7875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE DOCTORS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIVERSICARE TEXAS I, LLC",
        "enumeration_date": "2007-07-19",
        "last_updated": "2023-04-07",
        "certification_date": "2023-04-07",
        "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",
        "authorized_official_telephone_number": "615-550-9459"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "130500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001015188",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diversicare of Lake Highlands",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Diversicare of Lake Highlands",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Austin Jacob Dittrich, PA
• Matthew Gerald Ditzler, MD
• Divali Docs, PLLC (DFW Bariatrics and General Surgery)
• Abhay Ashok Divekar, MD, MBBS
• Diverge and Bloom Counseling, PLLC
• Diversicare Treemont LLC (Treemont Healthcare and Rehabilitation Center)
• Divine Behavioral Health Clinic PLLC
• Divine Care Hospice LLC
• Divine Healing Space, PLLC
• Divine Healing Supplies

• Skilled Nursing Facility in Dallas, TX
• Providers in Dallas, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2023; 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.