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Organization

DIVERSICARE OF SEINA WOODS, LLC

Active
Parent organization
DIVERSICARE LEASING COMPANY II, LLC
Other names
Diversicare of Siena Woods
Organization subpart
Yes

Provider details

NPI number
Legal business name
DIVERSICARE LEASING COMPANY II, LLC
Authorized official
KELLY J GILL (PRESIDENT AND CEO)
(615) 771-7575
Entity
Organization

Contact information

Practice address
6125 N MAIN ST, DAYTON, OH 45415-3110
(937) 278-8211
(937) 278-8046
Mailing address
6125 N MAIN ST, DAYTON, OH 45415-3110
(937) 278-8211
(937) 278-8046

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
2379R
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
36-5819
MEDICARE
OH
Enumeration date
04/27/2015
Last updated
04/27/2015
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