# DIVERSICARE CHISOLM, 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 LP
- **Other names:** Chisolm Trail Nursing & Rehab Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1437191285
- **Legal business name:** DIVERSICARE LEASING LP
- **Authorized official:** MATTHEW J WEISHAAR (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (615) 550-9459

## Contact information

- **Practice address:** 107 N MEDINA ST, LOCKHART, TX 78644-1919
- **Practice address phone:** (512) 398-5213
- **Practice address fax:** (512) 376-6880
- **Mailing address:** 1621 GALLERIA BLVD, BRENTWOOD, TN 37027-2926
- **Mailing address phone:** (615) 550-9453
- **Mailing address fax:** (615) 915-9635

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 137734 | TX | Yes |

## Other

- **Enumeration date:** 06/12/2006
- **Last updated:** 04/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4891 | — | TX |