Provider Demographics
NPI:1235338732
Name:DIVERSICARE TREEMONT LLC
Entity Type:Organization
Organization Name:DIVERSICARE TREEMONT LLC
Other - Org Name:TREEMONT 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 1:5550 HARVEST HILL RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1624
Mailing Address - Country:US
Mailing Address - Phone:972-661-1862
Mailing Address - Fax:972-980-6731
Practice Address - Street 1:5550 HARVEST HILL RD
Practice Address - Street 2:SUITE 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1624
Practice Address - Country:US
Practice Address - Phone:972-661-1862
Practice Address - Fax:972-980-6731
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVOCAT INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-13
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120029314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-5823OtherMEDICARE SNF
TX455823Medicare Oscar/Certification
4512200644504Medicare Oscar/Certification