NPIMap

Organization Active NPI

Jacksonville Health and Rehabilitation, LLC

  • Skilled Nursing Facility
  • Jacksonville, AL
National Provider Identifier
1033166640
Registry record updated Oct 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
JACKSONVILLE HEALTH AND REHABILITATION, LLC
Practice address
410 Wilson Dr SW
Jacksonville, AL 36265-2754
Phone
(256) 435-7704
NPI assigned
May 28, 2006
Last updated
Oct 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2020

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

Authorized official

Name
Phillip Cody Long
Title
Cfo
Phone
(205) 391-3600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

410 Wilson Dr SW
Jacksonville, AL 36265-2754

Mailing address

410 Wilson Dr SW
Jacksonville, AL 36265-2754
Phone (256) 435-7704

Other identifiers 2

IdentifierTypeStateIssuer
4757820SMedicaidAL
012231OtherALBCBS ID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051115000154 AL Part A Provider - Skilled Nursing Facility 8426076548 Practice locations: Jacksonville, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033166640. Details of each certification follow.

Skilled nursing facility certification: CCN 015391

Legal name
JACKSONVILLE HEALTH AND REHABILITATION, LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 23, 1986
Last certification
Sep 29, 2023
Beds
167
Ownership / control type
Corporation
Multi-facility organization
NORTHPORT HEALTH SERVICES
Organization structure
LLCProprietary
Enrollment address
410 Wilson Dr SW
Jacksonville, AL 36265-2754
Nursing home name
JACKSONVILLE HEALTH AND REHABILITATION, LLC
Affiliated entity
NHS MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Jacksonville Health and Rehabilitation, LLCCCN 015391 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Oct 23, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
167147.9 residents per day on average
Chain
NHS Management43 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Tammy Cox Individual Corporate DirectorRegional Nurse Consultant Oct 23, 2023 33%
Operational/Managerial ControlRegional Nurse Consultant Oct 23, 2023 33%
James Norman Estes Jr TR Organization, Vestavia, AL 5% Or Greater Indirect Ownership Interest Jun 30, 2013 6.25%
Lynn S Rasco Individual Corporate DirectorDirector of Qa/Corp Compliance Ofcr Jul 1, 2022 33%
Operational/Managerial ControlDirector of Qa/Corp Compliance Ofcr Jul 1, 2022 33%
Jennifer Lee Estes TR 031093 Organization, Vestavia, AL 5% Or Greater Indirect Ownership Interest Jun 30, 2013 6.25%
James Norman Estes Individual 5% Or Greater Indirect Ownership InterestPresident/Treasurer Jan 12, 2000 51%
Corporate OfficerPresident/Treasurer Jan 12, 2000 100%
Holding Facilities Group LLC Organization, Tuscaloosa, AL LLC, For-profit, Owned by another organization or individual 5% Or Greater Security Interest Sep 1, 2013
Adp of the SNF Feb 5, 2025
Phillip Cody Long Individual Corporate OfficerVice President/Secretary Oct 1, 2019
Jennifer E Agee Family Dynasty TR No 2 Organization, Tuscaloosa, AL 5% Or Greater Indirect Ownership Interest Dec 27, 2012 18.25%
Northport Holding Operations, LLC Organization, Tuscaloosa, AL LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Jan 31, 2003 100%
David P. Odell Individual Operational/Managerial Control Sep 3, 2024
Adp of the SNF Feb 5, 2025
James N Estes Jr Family Dynasty TR No 2 Organization, Tuscaloosa, AL 5% Or Greater Indirect Ownership Interest Dec 27, 2012 18.25%
Jacksonville Health Realty LLC Organization, Tuscaloosa, AL LLC, For-profit 5% Or Greater Security Interest Sep 1, 2013
Derek Patterson Individual Operational/Managerial Control Apr 15, 2024
Managing Control - Governing BodyBoard Member Apr 15, 2024
Capital Funding LLC Organization, Baltimore, MD LLC, Financial institution, For-profit 5% Or Greater Mortgage Interest Sep 1, 2013 94.1%
5% Or Greater Security Interest Sep 1, 2013 94.1%
Servisfirst Bank Organization, Birmingham, AL Corporation, Financial institution, For-profit 5% Or Greater Security Interest Aug 29, 2018

Facilities with the same owner 42

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

View all 42

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602460800000",
    "number": "1033166640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 WILSON DR SW",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "362652754",
            "telephone_number": "256-435-7704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 WILSON DR SW",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "362652754",
            "telephone_number": "256-435-7704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE HEALTH AND REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "CODY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "205-391-3600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4757820S",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ID",
            "identifier": "012231",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, AL

Sources for this page

Verify at the official NPI Registry.