Organization
DIVERSICARE LEASING LP
Active
Other names
Lynwood Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW J. WEISHAAR JR. (CFO/SECRETARY)
(615) 550-9459
Entity
Organization
Contact information
Practice address
4164 HALLS MILL RD, MOBILE, AL 36693-5614
(251) 661-5404
(251) 661-5407
Mailing address
4164 HALLS MILL RD, MOBILE, AL 36693-5614
(251) 661-5404
(251) 661-5407
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
N4907
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47-54270S
—
AL
Enumeration date
10/05/2005
Last updated
01/19/2023
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