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Organization

DIVERSICARE CHISOLM, LLC

Active
Parent organization
DIVERSICARE LEASING LP
Other names
Chisolm Trail Nursing & Rehab Center
Organization subpart
Yes

Provider details

NPI number
Legal business name
DIVERSICARE LEASING LP
Authorized official
MATTHEW J WEISHAAR (CHIEF FINANCIAL OFFICER)
(615) 550-9459
Entity
Organization

Contact information

Practice address
107 N MEDINA ST, LOCKHART, TX 78644-1919
(512) 398-5213
(512) 376-6880
Mailing address
1621 GALLERIA BLVD, BRENTWOOD, TN 37027-2926
(615) 550-9453
(615) 915-9635

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
137734
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4891
TX
Enumeration date
06/12/2006
Last updated
04/07/2023
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