NPIMap

Organization Active NPI

Coosa Valley Healthcare Center LLC

  • Skilled Nursing Facility
  • Sylacauga, AL
National Provider Identifier
1013401132
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
18101 Issued in AL
Legal business name
COOSA VALLEY HEALTHCARE CENTER LLC
Practice address
315 W Hickory St
Sylacauga, AL 35150-2913
Phone
(256) 401-4324
Fax
(256) 401-4696
NPI assigned
Jun 21, 2018
Last updated
Jun 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas Gilliland
Title
Regional Financial Consultant
Phone
(256) 825-9274

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 18101 AL Primary

Addresses

Primary practice location

315 W Hickory St
Sylacauga, AL 35150-2913

Mailing address

314 W Columbus St
Dadeville, AL 36853-1337
Phone (256) 825-9274

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190225001401 AL Part A Provider - Skilled Nursing Facility 9830434646 Practice locations: Sylacauga, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013401132. Details of each certification follow.

Skilled nursing facility certification: CCN 015010

Legal name
COOSA VALLEY HEALTHCARE CENTER LLC
Doing business as
COOSA VALLEY HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1967
Last certification
Apr 9, 2022
Beds
85
Ownership / control type
Corporation
Most recent change of ownership
Aug 1, 2004
Organization structure
LLCProprietary
Incorporated
May 23, 2018 in AL
Enrollment address
260 W Walnut St
Sylacauga, AL 35150-3316
Nursing home name
COOSA VALLEY HEALTHCARE CENTER
Affiliated entity
PRIME HEALTH CARE ENTERPRISES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Coosa Valley Healthcare CenterCCN 015010 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jan 1, 1967
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8580.1 residents per day on average
Chain
Prime Health Care Enterprises5 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2151407Coosa Valley Healthcare Center LLC260 W Walnut Street, Sylacauga, AL 35150Certificate of waiverJul 17, 2026

National Provider Directory

National Provider Directory

Locations

260 W Walnut St
Sylacauga, AL 35150
Phone (256) 487-0308

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Archie J. Chapman Individual 5% Or Greater Direct Ownership InterestPresident Nov 16, 2018 100%
Corporate OfficerPresident Nov 16, 2018 100%
Corporate DirectorPresident Nov 16, 2018 100%
Operational/Managerial ControlPresident Nov 16, 2018 100%
Prime Management, LLC Organization, Dadeville, AL LLC Operational/Managerial Control Nov 16, 2018

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1013401132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 W COLUMBUS ST",
            "city": "DADEVILLE",
            "state": "AL",
            "postal_code": "368531337",
            "telephone_number": "256-825-9274",
            "fax_number": "256-825-9276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W HICKORY ST",
            "city": "SYLACAUGA",
            "state": "AL",
            "postal_code": "351502913",
            "telephone_number": "256-401-4324",
            "fax_number": "256-401-4696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOSA VALLEY HEALTHCARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-21",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "GILLILAND",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "REGIONAL FINANCIAL CONSULTANT",
        "authorized_official_telephone_number": "256-825-9274"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AL",
            "license": "18101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sylacauga, AL

Sources for this page

Verify at the official NPI Registry.