| Name: | Diversicare of Bessemer, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 01 Jul 2016 (9 years ago) |
| Entity Number: | 000-369-274 |
| Register Number: | 000369274 |
| ZIP code: | 36104 |
| County: | Montgomery |
| Place of Formation: | Delaware |
| Principal Address: | 1621 Galleria BoulevardBrentwood, TN 37027 |
| Registered Office Street Address: | 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538614755 | 2016-08-17 | 2023-04-07 | 1621 GALLERIA BLVD, BRENTWOOD, TN, 370272926, US | 820 GOLF COURSE RD, BESSEMER, AL, 350226024, US | |||||||||||||||||||||||||||||
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| Phone | +1 615-550-9453 |
| Fax | 6159156935 |
| Phone | +1 205-425-5241 |
| Fax | 2054266262 |
Authorized person
| Name | MATTHEW J. WEISHAAR |
| Role | CHIEF FINANCIAL OFFICER & SECRETARY |
| Phone | 6157717575 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 3708 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 200818 |
| State | AL |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 7UVB5 | Active | Non-Manufacturer | 2017-05-04 | 2024-01-19 | 2029-01-19 | 2025-01-16 | |||||||||||||||
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| POC | ANDREA RILEY |
| Phone | +1 615-550-9453 |
| Fax | +1 615-915-6935 |
| Address | 820 GOLF COURSE RD, BESSEMER, AL, 35022 6024, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | Information not Available |
|---|
| List of Offerors (0) | Information not Available |
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| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY INC | Agent | 251 LITTLE FALLS DRIVEWILMINGTON, DE 19808 |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
