# DIVERSICARE OF ELLINWOOD, LLC

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

## Provider details

- **NPI number:** 1780063743
- **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:** 510 W 7TH ST, ELLINWOOD, KS 67526-1101
- **Practice address phone:** (620) 564-2337
- **Practice address fax:** (615) 620-7875
- **Mailing address:** 510 W 7TH ST, ELLINWOOD, KS 67526-1101
- **Mailing address phone:** (620) 564-2337
- **Mailing address fax:** (615) 620-7875

## Taxonomy

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

## Other

- **Enumeration date:** 05/23/2015
- **Last updated:** 05/23/2015