Provider Demographics
NPI:1235326349
Name:DIVERSICARE PARIS, LLC
Entity Type:Organization
Organization Name:DIVERSICARE PARIS, LLC
Other - Org Name:BRENTWOOD TERRACE HEALTHCARE AND REHABILITATION CENTER
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 1:2885 STILLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-2042
Mailing Address - Country:US
Mailing Address - Phone:903-784-4111
Mailing Address - Fax:903-784-7121
Practice Address - Street 1:2885 STILLHOUSE RD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-2042
Practice Address - Country:US
Practice Address - Phone:903-784-4111
Practice Address - Fax:903-784-7121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVOCAT INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-02
Last Update Date:2012-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127763314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-6045OtherMEDICARE SNF
6712200644502Medicare Oscar/Certification