DIVERSICARE OF TYLERTOWN, LLC (NPI# 1083169072) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083169072 |
| Entity Type | Organization |
| Organization Name | DIVERSICARE OF TYLERTOWN, LLC |
| Other Organization Name | DIVERSICARE OF TYLERTOWN |
| Practice Address |
200 Medical Cir Tylertown MS 39667-2069 |
| Practice Telephone | 6018762107 |
| Practice Fax Number | 6156207875 |
| Mailing Telephone | 6018762107 |
| Mailing Fax Number | 6156207875 |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2017-02-14 |
| Authorized Official Name | KELLY J GILL (CEO) |
| Authorized Official Telephone | 6157717575 |
| Is Organization Subpart | Y |
| Parent Organization Name | DIVERSICARE LEASING COMPANY III, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 390 | MS | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00023146 | 05 |
| Other Name | Type Code |
|---|---|
| Diversicare of Tylertown | Doing Business As Name - Organization |
| Street Address |
200 MEDICAL CIR |
| City | TYLERTOWN |
| State | MS |
| Zip Code | 39667-2069 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396796918 | Ggnsc Tylertown LLC | Skilled Nursing Facility | 200 Medical Cir, Tylertown, MS 39667-2069 | 2006-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891212221 | Lavarshia Newsome-pittman | Pharmacist | 3000 Plaza Drive, Tylertown, MS 39667 | 2017-08-25 |
| 1891171039 | Tanya Marie Holmes-morris | Home Health Aide | 42 West Mt. Olive Rd, Tylertown, MS 39667 | 2015-08-10 |
| 1376776930 | Family Health Care Clinic, Inc. | Clinic/Center | 225 Saint Paul Road, Tylertown, MS 39667 | 2009-08-31 |
| 1427221290 | Family Health Care Clinic, Inc. | Clinic/Center | 113 Enoch St, Tylertown, MS 39667 | 2008-04-11 |
| 1275651879 | John C Barrett | Dentist | 75 Old Hwy 98 E, Tylertown, MS 39667 | 2007-03-26 |
| 1497895551 | L & L Hospice, Inc. | Hospice Care, Community Based | 423 A Beulah, Tylertown, MS 39667 | 2007-02-07 |
| 1114009610 | Ruthie L Lewis | Licensed Practical Nurse | 423a Beulah Avenue, Tylertown, MS 39667 | 2006-10-20 |
| 1245512417 | Walthall General Hospital | Internal Medicine | 100 Hospital Drive, Tylertown, MS 39667 | 2011-09-14 |
| 1255649604 | Walthall General Hospital | General Acute Care Hospital | 200 Hospital Dr, Tylertown, MS 39667 | 2010-09-20 |
| 1407499296 | Belinda May Ratcliff | Pharmacist | 201 Hospital Dr, Tylertown, MS 39667-2019 | 2019-10-23 |
| Find all providers in zip 39667 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396796918 | Ggnsc Tylertown LLC | Skilled Nursing Facility | 200 Medical Cir, Tylertown, MS 39667-2069 | 2006-05-16 |
| 1013109479 | Billdora Senior Care LLC | Skilled Nursing Facility | 314 Enochs St, Tylertown, MS 39667-2716 | 2007-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427575505 | Trend Health and Rehab of Carthage | Skilled Nursing Facility | 1101 E. Franklin Street, Carthage, MS 39051 | 2017-08-29 |
| 1053834747 | St. Catherine's Village, Inc | Skilled Nursing Facility | 200 Dominican Dr, Madison, MS 39110-8630 | 2017-07-25 |
| 1851839435 | Parker Medical Services, LLC | Skilled Nursing Facility | 1060 Lisa Ln, Terry, MS 39170-8092 | 2017-02-03 |
| 1114386687 | Genesis Healthcare | Skilled Nursing Facility | 2142 E Whitworth St, Hazlehurst, MS 39083-9277 | 2016-02-12 |
| 1003274150 | Vincent Huffstutler | Skilled Nursing Facility | 201 Mary Ellen Dr, Ripley, MS 38663-1658 | 2016-02-04 |
| 1942614219 | Adams Home Care | Skilled Nursing Facility | 225 Moore St, Pearl, MS 39208 | 2014-06-16 |
| 1861817603 | Meadowbrook Health & Rehab LLC | Skilled Nursing Facility | 211 Windmill Drive, Meridian, MS 39305 | 2014-03-04 |
| 1679819890 | Global Home Care, LLC | Skilled Nursing Facility | 4213 Pruitt Rd, West Point, MS 39773-4517 | 2012-12-14 |
| 1740526961 | Better Living Home Care, LLC | Skilled Nursing Facility | 1295 Simpson Park Rd, Weir, MS 39772-8805 | 2012-12-14 |
| 1700132065 | The Arbor | Skilled Nursing Facility | 600 S Pear Orchard Rd, Ridgeland, MS 39157-4221 | 2012-07-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.