Diversicare of Tylertown, LLC
NPI 1083169072 · Skilled Nursing Facility · Tylertown, MS
Enrolled with Medicare as Part a Provider - Skilled Nursing Facility · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Diversicare of Tylertown, LLC is a Skilled Nursing Facility organization in Tylertown, MS (NPI 1083169072).
Provider details
- NPI number
- 1083169072
- Entity type
- Organization
- Primary specialty
- Skilled Nursing FacilityNursing & Custodial Care Facilities
- Parent organization
- Diversicare Leasing Company III, LLC
- Organization subpart
- Yes
- Authorized official
- Matthew Weishaar, Chief Financial Officer(615) 550-9459
- License
- 390 (MS)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Diversicare of Tylertown
- Doing business as
- Diversicare of Tylertown
Registry dates
- Enumerated
- 2016-08-18
- Last updated
- 2023-04-07
- Certified
- 2023-04-07
Frequently asked questions
- What is Diversicare of Tylertown, LLC's NPI number?
- Diversicare of Tylertown, LLC's National Provider Identifier (NPI) is 1083169072, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Diversicare of Tylertown, LLC?
- Diversicare of Tylertown, LLC is classified in the NPPES registry as Skilled Nursing Facility (Nursing & Custodial Care Facilities).
- Where is Diversicare of Tylertown, LLC located?
- Diversicare of Tylertown, LLC's practice location on file with NPPES is 200 Medical Cir, Tylertown, MS 39667-2069.
- What is Diversicare of Tylertown, LLC's phone number?
- The practice phone number listed in the NPPES registry for Diversicare of Tylertown, LLC is (601) 876-2107.
- Does Diversicare of Tylertown, LLC accept Medicare?
- Diversicare of Tylertown, LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Diversicare of Tylertown, LLC?
- The authorized official listed on Diversicare of Tylertown, LLC's NPPES record is Matthew Weishaar, Chief Financial Officer. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Diversicare of Tylertown, LLC's NPI active?
- Yes — Diversicare of Tylertown, LLC's NPI (1083169072) is active in the NPPES registry as of the last update on 2023-04-07.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.