Provider Demographics
NPI:1104184787
Name:DIVERSICARE CLINTON, LLC
Entity Type:Organization
Organization Name:DIVERSICARE CLINTON, LLC
Other - Org Name:ARBOR PLACE OF CLINTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & 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 1:106 PADGETT DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:KY
Mailing Address - Zip Code:42031-1313
Mailing Address - Country:US
Mailing Address - Phone:270-653-5558
Mailing Address - Fax:270-653-5522
Practice Address - Street 1:106 PADGETT DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:KY
Practice Address - Zip Code:42031-1313
Practice Address - Country:US
Practice Address - Phone:270-653-5558
Practice Address - Fax:270-653-5522
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVOCAT INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility