Organization
DIVERSICARE LEASING CORP.
Active
Other names
West Liberty 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
774 LIBERTY RD, WEST LIBERTY, KY 41472-2052
(606) 743-3846
(606) 743-2540
Mailing address
774 LIBERTY RD, WEST LIBERTY, KY 41472-2052
(606) 743-3846
(606) 743-2540
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100340
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12503017
—
KY
Enumeration date
10/11/2005
Last updated
08/22/2020
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