# DIVERSICARE OF GREENVILLE, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DIVERSICARE LEASING COMPANY II, LLC
- **Other names:** Diversicare of Greenville
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1184024424
- **Legal business name:** DIVERSICARE LEASING COMPANY II, LLC
- **Authorized official:** KELLY J GILL (PRESIDENT AND CEO)
- **Authorized official phone:** (615) 771-7575

## Contact information

- **Practice address:** 521 GREENE DR, GREENVILLE, KY 42345-1409
- **Practice address phone:** (270) 338-1523
- **Practice address fax:** (615) 620-7875
- **Mailing address:** 521 GREENE DR, GREENVILLE, KY 42345-1409
- **Mailing address phone:** (270) 338-1523
- **Mailing address fax:** (615) 620-7875

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 08/22/2014
- **Last updated:** 10/21/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100364170 | — | KY |