Provider Demographics
NPI:1649725722
Name:DIVERSICARE OF FOLEY, LLC
Entity type:Organization
Organization Name:DIVERSICARE OF FOLEY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEISHAAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-550-9459
Mailing Address - Street 1:1701 N ALSTON ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2246
Mailing Address - Country:US
Mailing Address - Phone:251-943-2781
Mailing Address - Fax:615-620-7875
Practice Address - Street 1:1701 N ALSTON ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2246
Practice Address - Country:US
Practice Address - Phone:251-943-2781
Practice Address - Fax:251-943-6256
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVERSICARE LEASING COMPANY III, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-18
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL199899Medicaid