Organization
DIVERSICARE OF RIVERSIDE, LLC
Active
Parent organization
DIVERSICARE LEASING COMPANY II, LLC
Other names
Riverside Place
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIVERSICARE LEASING COMPANY II, LLC
Authorized official
MATTHEW J WEISHAAR (CHIEF FINANCIAL OFFICER)
(615) 771-7575
Entity
Organization
Contact information
Practice address
1616 WEISENBORN RD, SAINT JOSEPH, MO 64507-2527
(816) 232-9874
(816) 364-4283
Mailing address
1616 WEISENBORN RD, SAINT JOSEPH, MO 64507-2527
(816) 232-9874
(816) 364-4283
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
042402
MO
314000000X
Skilled Nursing Facility
Primary
042401
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669887352
—
MO
Enumeration date
06/22/2014
Last updated
04/07/2023
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