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Organization
DIVERSICARE CHISOLM, LLC
Active
Organization
DIVERSICARE CHISOLM, LLC
Active
Parent organization
DIVERSICARE LEASING LP
Other names
Chisolm Trail Nursing & Rehab Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIVERSICARE LEASING LP
Authorized official
MATTHEW J WEISHAAR (CHIEF FINANCIAL OFFICER)
(615) 550-9459
Entity
Organization
Contact information
Practice address
107 N MEDINA ST, LOCKHART, TX 78644-1919
(512) 398-5213
(512) 376-6880
Mailing address
1621 GALLERIA BLVD, BRENTWOOD, TN 37027-2926
(615) 550-9453
(615) 915-9635
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
137734
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4891
—
TX
Enumeration date
06/12/2006
Last updated
04/07/2023
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