DIVERSICARE OF MONTGOMERY, LLC (NPI# 1366997454) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366997454 |
| Entity Type | Organization |
| Organization Name | DIVERSICARE OF MONTGOMERY, LLC |
| Other Organization Name | DIVERSICARE OF MONTGOMERY |
| Practice Address |
2020 N Country Club Dr Montgomery AL 36106-1614 |
| Practice Telephone | 3342631643 |
| Practice Fax Number | 6156207875 |
| Mailing Telephone | 3342631643 |
| Mailing Fax Number | 6156207875 |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2017-03-05 |
| 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 | AL | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Diversicare of Montgomery | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Alabama Business Registrations | Diversicare of Montgomery, LLC | 1621 Galleria Boulevard, Brentwood, TN 37027 |
| Street Address |
2020 N COUNTRY CLUB DR |
| City | MONTGOMERY |
| State | AL |
| Zip Code | 36106-1614 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114978707 | Ggnsc Montgomery LLC | Skilled Nursing Facility | 2020 N Country Club Dr, Montgomery, AL 36106-1614 | 2006-05-16 |
| 1295381093 | Jeremy Petrich | Physical Therapist | 2020 N Country Club Dr, Montgomery, AL 36106-1614 | 2019-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235747205 | Rural Urgent Care LLC | Clinic/Center | 3039 Vaughn Road, Montgomery, AL 36106 | 2020-07-16 |
| 1548733306 | Bennett Family Dentistry, LLC | Dentist | 4270 Carmichael Road, Montgomery, AL 36106 | 2019-01-04 |
| 1588133854 | Lori Leanne Fail | Physical Therapist | 1615 Windsor Hill Court, Montgomery, AL 36106 | 2018-11-16 |
| 1073020749 | Charlene Richmond Harrell | Chiropractor | 2900 Zelda Rd., Suite A, Montgomery, AL 36106 | 2018-01-03 |
| 1780123109 | Montgomery Accident and Injury Center, Inc | Nurse Practitioner | 2900 Zelda Rd, Ste B, Montgomery, AL 36106 | 2017-02-17 |
| 1467843573 | Ernest Porterfield | Non-emergency Medical Transport (VAN) | 4183 Carmichael Road, Suite A, Montgomery, AL 36106 | 2015-02-11 |
| 1114334281 | Daniel Gerald O'bryant | Specialist/Technologist | 1160 Navarro Avenue, Montgomery, AL 36106 | 2014-07-21 |
| 1801213764 | Amanda Hodge | Specialist/Technologist | 4605 Cherry Tree Terrace, Montgomery, AL 36106 | 2014-03-27 |
| 1871861542 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1758 Park Pl Ste 102, Montgomery, AL 36106 | 2011-12-08 |
| 1578862546 | Helping Hands Preventitive Health Center | Community/Behavioral Health | 2015 Mulberry St, Montgomery, AL 36106 | 2011-03-16 |
| Find all providers in zip 36106 | ||||
| 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 |
|---|---|---|---|---|
| 1225347495 | Montgomery Children's Specialty Center, LLC | Skilled Nursing Facility | 2853 Forbes, Montgomery, AL 36110-1307 | 2010-10-05 |
| 1942321872 | Ssc Montgomery South Haven Operating Company LLC | Skilled Nursing Facility | 1300 E South Blvd, Montgomery, AL 36116-2318 | 2007-04-02 |
| 1194845255 | Ssc Montgomery Cedar Crest Operating Company LLC | Skilled Nursing Facility | 4490 Virginia Loop Rd, Montgomery, AL 36116-3448 | 2007-03-30 |
| 1871684324 | Montgomery General Hospital, Inc. | Skilled Nursing Facility | 401 Sixth Avenue, Montgomery, WV 25136 | 2006-09-28 |
| 1053410985 | Montgomery General Elderly Care Center, Inc. | Skilled Nursing Facility | 501 Adams St, Montgomery, WV 25136-2124 | 2006-09-21 |
| 1134237373 | John Knox Manor Inc II | Skilled Nursing Facility | 4401 Narrow Lane Rd, Montgomery, AL 36116-2953 | 2006-08-28 |
| 1932216488 | Ssc Montgomery Woodley Manor Opr Co. LLC | Skilled Nursing Facility | 3312 Woodley Rd, Montgomery, AL 36116-3155 | 2006-08-23 |
| 1114978707 | Ggnsc Montgomery LLC | Skilled Nursing Facility | 2020 N Country Club Dr, Montgomery, AL 36106-1614 | 2006-05-16 |
| 1609864602 | Newport Long Term Care, Inc. | Skilled Nursing Facility | 46 Main Rd, Montgomery, MA 01085-9511 | 2005-10-12 |
| 1871590927 | Trinity Healthcare Corporation | Skilled Nursing Facility | 8211 Weller Rd, Montgomery, OH 45242-3208 | 2005-07-05 |
| Find all providers in MONTGOMERY | ||||
| City | MONTGOMERY |
| Zip Code | 36106 |
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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.