Organization
DIVERSICARE LEASING CORP.
Active
Other names
Hillcrest Manor Nursing & Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND L. TYLER JR. (EXECUTIVE VICE PRESIDENT AND COO)
(615) 771-7575
Entity
Organization
Contact information
Practice address
HOUSTON HIGHWAY, LULING, TX 78648-0230
(830) 875-5219
(830) 875-2919
Mailing address
PO BOX 230, LULING, TX 78648-0230
(830) 875-5219
(830) 875-2919
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
115095
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4820
—
TX
Enumeration date
10/19/2005
Last updated
08/22/2020
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