# DIVERSICARE OF FULTON, 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 HOLDING COMPANY, LLC
- **Other names:** Diversicare of Fulton
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1306218839
- **Legal business name:** DIVERSICARE HOLDING COMPANY, LLC
- **Authorized official:** KELLY J GILL (PRESIDENT AND CEO)
- **Authorized official phone:** (615) 771-7575

## Contact information

- **Practice address:** 1004 HOLIDAY LN, FULTON, KY 42041-8458
- **Practice address phone:** (270) 472-1971
- **Practice address fax:** (270) 472-3375
- **Mailing address:** 1004 HOLIDAY LN, FULTON, KY 42041-8458
- **Mailing address phone:** (270) 472-1971
- **Mailing address fax:** (270) 472-3375

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 100132 | KY | Yes |

## Other

- **Enumeration date:** 10/23/2015
- **Last updated:** 05/01/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100395670 | — | KY |