Organization
DIVERSICARE LEASING CORP.
Active
Other names
Yorktown 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
670 W 4TH ST, YORKTOWN, TX 78164-5092
(361) 564-2275
(361) 564-3593
Mailing address
670 W 4TH ST, YORKTOWN, TX 78164-5092
(361) 564-2275
(361) 564-3593
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
114687
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4759
—
TX
Enumeration date
10/17/2005
Last updated
08/22/2020
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