Organization
DIVERSICARE LEASING LP
Active
Other names
Canterbury Healthcare Facility
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW J. WEISHAAR (CHIEF FINANCIAL OFFICER & SECRETARY)
(615) 771-7575
Entity
Organization
Contact information
Practice address
1720 KNOWLES RD, PHENIX CITY, AL 36869-7135
(334) 291-0486
(334) 297-5816
Mailing address
1720 KNOWLES RD, PHENIX CITY, AL 36869-7135
(334) 291-0486
(334) 297-5816
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
N5704
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47-57740S
—
AL
Enumeration date
10/01/2005
Last updated
10/25/2022
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