Diversicare of Canon City, LLC
NPI #1497134456 in Canon City, Colorado
Provider Information
- NPI Number
- 1497134456
- Entity Type
- Organization
- Organization Name
- Diversicare of Canon City, LLC
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- DIVERSICARE LEASING COMPANY II, LLC
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- May 23, 2015
- Last Updated
- May 23, 2015
Practice Location
- Address
- 515 FAIRVIEW AVE
- City
- Canon City
- State
- Colorado
- ZIP Code
- 81212-2863
- Phone
- (719) 275-0665
Authorized Official
- Name
- KELLY J GILL
- Title
- PRESIDENT & CEO
- Phone
- (615) 771-7575
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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