Organization
DIVERSICARE OF FULTON, LLC
Active
Parent organization
DIVERSICARE HOLDING COMPANY, LLC
Other names
Diversicare of Fulton
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIVERSICARE HOLDING COMPANY, LLC
Authorized official
KELLY J GILL (PRESIDENT AND CEO)
(615) 771-7575
Entity
Organization
Contact information
Practice address
1004 HOLIDAY LN, FULTON, KY 42041-8458
(270) 472-1971
(270) 472-3375
Mailing address
1004 HOLIDAY LN, FULTON, KY 42041-8458
(270) 472-1971
(270) 472-3375
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100132
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100395670
—
KY
Enumeration date
10/23/2015
Last updated
05/01/2016
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