SOUTH SHORE NURSING & REHABILITATION CENTER
NPI 1477541688
Skilled Nursing Facility in South Shore, KY

Active since October 11, 2005CLIA 18D0324849 · Waiver
489 JAMES HANNAH DRIVE, SOUTH SHORE, KY 41175(606) 932-3127(606) 932-4663 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About South Shore Nursing & Rehabilitation Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTH SHORE NURSING & REHABILITATION CENTER (NPI 1477541688) is a healthcare organization registered as a skilled nursing facility in South Shore, Kentucky and active in the NPI registry since October 2005. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Raymond L. Tyler, Executive Vice President And Coo, as its authorized official.

NPPES Registry Identity

NPI1477541688
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameDIVERSICARE LEASING CORP.
Location Address489 JAMES HANNAH DRIVESouth Shore, KY 41175-0489
Mailing AddressPo Box 489, James Hannah DriveSouth Shore, KY 41175-0489 · (606) 932-3127 · Fax (606) 932-4663
Fax(606) 932-4663
Organization SubpartNo
Authorized OfficialRaymond L. TylerExecutive Vice President And Coo · (615) 771-7575
Enumeration DateOctober 11, 2005
Last NPPES UpdateAugust 22, 2020
NPI 1477541688 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in KY · 100156
Definition
(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.
489 JAMES HANNAH DRIVE, South Shore, KY 41175

Other Names 1

Doing Business AsSouth Shore Nursing & Rehabilitation Center

Other Identifiers 1

Medicaid12503025KY

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 18D0324849

South Shore Nursing And Rehabilitation, LLC · South Shore, KY
Active · expires Aug 31, 2026
CLIA Number18D0324849
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorMs. Angie Dummitt
Laboratory Phone(606) 932-3127
Laboratory LocationSouth Shore Nursing And Rehabilitation, LLCPO Box 489, South Shore, KY 41175
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Diversicare Leasing Corp.'s NPI number?

The NPI number for Diversicare Leasing Corp. is 1477541688. It was assigned to this organization in the NPPES registry on October 11, 2005. The provider is doing business as South Shore Nursing & Rehabilitation Center.

Where is Diversicare Leasing Corp. located?

Diversicare Leasing Corp. is located at 489 James Hannah Drive, South Shore, KY 41175. The listed phone number is (606) 932-3127.

What is Diversicare Leasing Corp.'s specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Diversicare Leasing Corp. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 18D0324849) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Diversicare Leasing Corp. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.