Organization
DIVERSICARE LEASING CORP.
Active
Other names
Lampasas 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
611 N BROAD ST, LAMPASAS, TX 76550-1105
(512) 556-3588
(512) 556-2507
Mailing address
611 N BROAD ST, LAMPASAS, TX 76550-1105
(512) 556-3588
(512) 556-2507
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
115094
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4222
—
TX
Enumeration date
10/17/2005
Last updated
08/22/2020
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