Organization
DIVERSICARE OF NICHOLASVILLE, LLC
Active
Parent organization
DIVERSICARE LEASING COMPANY II, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIVERSICARE LEASING COMPANY II, LLC
Authorized official
KELLY J GILL (PRESIDENT AND CEO)
(615) 771-7575
Entity
Organization
Contact information
Practice address
100 SPARKS AVE, NICHOLASVILLE, KY 40356-1004
(859) 885-4171
(615) 620-7875
Mailing address
100 SPARKS AVE, NICHOLASVILLE, KY 40356-1004
(859) 885-4171
(615) 620-7875
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100323260
—
KY
Enumeration date
05/05/2014
Last updated
06/01/2015
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