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Contact Information

DIVERSICARE ROSE TERRACE, LLC
30 HIDDEN BROOK WAY
CULLODEN, WV25510
 Phone: 615-771-7575
 Fax: 615-620-7875
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
Indicates primary specialty

NPI Profile & details for DIVERSICARE ROSE TERRACE, LLC

NPI Number 1104117761
LBN Legal business name DIVERSICARE ROSE TERRACE, LLC
Authorized official KELLY GILL - (PRESIDENT AND CEO)
Entity Organization
Organization subpart 1 Yes
Enumeration date 04/29/2011
Last updated 11/14/2012 - About 14 years ago
Identifiers
WV License # 183
WV Medicaid 3810023465
WV Other 51-5192 MEDICARE SNF
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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