Organization
DIVERSICARE LEASING CORP.
Active
Other names
Elliott 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
RTE 32 E HOWARD CREEK RD, SANDY HOOK, KY 41171
(606) 738-9400
(606) 738-9410
Mailing address
PO BOX 694, RTE 32 E HOWARD CREEK RD, SANDY HOOK, KY 41171-0694
(606) 738-9400
(606) 738-9410
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100690
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12503066
—
KY
Enumeration date
10/12/2005
Last updated
08/22/2020
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