Provider Demographics
NPI:1013359694
Name:DIVERSICARE OF SENECA PLACE LLC
Entity Type:Organization
Organization Name:DIVERSICARE OF SENECA PLACE LLC
Other - Org Name:DIVERSICARE OF SENECA PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-771-7575
Mailing Address - Street 1:3526 DUTCHMANS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3256
Mailing Address - Country:US
Mailing Address - Phone:615-771-7575
Mailing Address - Fax:615-771-7409
Practice Address - Street 1:3526 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3256
Practice Address - Country:US
Practice Address - Phone:615-771-7575
Practice Address - Fax:615-771-7409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVERSICARE LEASING COMPANY II LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility