NPI 1083169072

Diversicare of Tylertown, LLC

Organisation Skilled Nursing Facility Tylertown, MS

Practice location

Address: 200 Medical Cir, Tylertown, MS 39667-2069
Phone: (601) 876-2107
Fax: (601) 876-5990
Mailing address: 1621 Galleria Blvd, Brentwood, TN 37027-2926

Authorised official

Name: Matthew J Weishaar
Title: Chief Financial Officer
Phone: (615) 550-9459

Registered specialties

Skilled Nursing Facility Primary

Nursing & Custodial Care Facilities Taxonomy 314000000X Licence 390 (MS)

Other Skilled Nursing Facility providers in Mississippi →

Registry record

NPI: 1083169072
Entity type: Organization
NPI issued: 18 Aug 2016
Record last updated: 7 Apr 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.