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DIVERSICARE OF MONTGOMERY LLC NPI 1366997454

NPI Profile

NPI: 1366997454
Provider Name: DIVERSICARE OF MONTGOMERY, LLC

Doing Business As: DIVERSICARE OF MONTGOMERY

Classification: Skilled Nursing Facility - 314000000X
Entity Type: Organization

CLIA Number: 01D0673387

Address:
2020 N COUNTRY CLUB DR
MONTGOMERY, AL
ZIP 36106
Get Directions

Phone: (334) 263-1643

DIVERSICARE OF MONTGOMERY, LLC is a skilled nursing facility in Montgomery, AL. The provider is (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. DIVERSICARE OF MONTGOMERY, LLC NPI is 1366997454. The provider is registered as an organization entity type.
The provider Is Doing Business As Diversicare Of Montgomery.

The provider's business location address is:

2020 N COUNTRY CLUB DR
MONTGOMERY, AL
ZIP 36106-614
Phone: (334) 263-1643
Fax: (615) 620-7875

The provider's authorized official is Kelly J Gill .
The authorized official title is Ceo and has the following contact phone number (615) 771-7575.

The CLIA number assigned to this NPI record is 01D0673387 - skilled nursing/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/18/2016 and was last updated on 3/5/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1314000000XSkilled Nursing FacilityALABAMAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1015040MEDICARE OSCAR/CERTIFICATIONALABAMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/24/2020

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