1114915782 NPI number — DIVERSICARE LEASING CORP.

Table of content: BRIAN D. LINDSAY M.D. (NPI 1508008566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114915782 NPI number — DIVERSICARE LEASING CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIVERSICARE LEASING CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114915782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2216 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES ARC
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72040-3100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-256-4194
Provider Business Mailing Address Fax Number:
870-256-1407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2216 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES ARC
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72040-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-256-4194
Provider Business Practice Location Address Fax Number:
870-256-1407
Provider Enumeration Date:
10/07/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TYLER
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT AND COO
Authorized Official Telephone Number:
615-771-7575

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  532 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)