LP Johnson City, LLC
Organization Active NPI Skilled Nursing Facility · Johnson City, TN
NPI 1043798424 · NPPES record last updated Sep 26, 2019
Key facts
- NPI
- 1043798424
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- LP JOHNSON CITY, LLC
- Practice address
- 401 Princeton Rd
Johnson City, TN 37601-2028 - Phone
- (423) 232-0070
- NPI assigned
- Jul 30, 2018
- Organization subpart
- No
Authorized official
- Name
- John Harrison
- Title
- Cfo
- Phone
- (502) 568-7800
Owners & managing parties with NPI records 23
Member of 2
Facilities with the same owner 88
Practitioners 3
-
Stanley M Hodges, MD
-
Randy W Hoover, MD
-
Sabrina D Miller, MD
Affiliated clinicians 4
-
Eric J Groen, DO
-
Randy W Hoover, MD
-
Patrick K Jones, D.O.
-
Sabrina D Miller, MD
Medicare Care Compare: Nursing home
- Listed as
- Princeton Transitional Care & Assisted Living
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★★★ 5 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare
- Ownership
- For profit - Corporation
- Certified
- Aug 25, 1995
- Medicare certification status
- Active
- Certified beds
- 47 · 42.8 residents per day on average
- Chain
- Signature Healthcare
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0964028 | LP Johnson City, LLC | Certificate of waiver | Jul 27, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Skilled nursing facility certification: CCN 445356
- Legal name
- LP JOHNSON CITY, LLC
- Doing business as
- PRINCETON TRANSITIONAL CARE AND ASSISTED LIVING
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF (Medicare) only
- Participating since
- Aug 25, 1995
- Last certification
- May 4, 2022
- Beds
- 47
- Ownership / control type
- Corporation
- Multi-facility organization
- Signature Healthcare
- Organization structure
- LLC · Proprietary
- Incorporated
- May 11, 2016 in DE
- Enrollment address
- 401 Princeton Rd
Johnson City, TN 37601-2028 - Nursing home name
- PRINCETON TRANSITIONAL CARE & ASSISTED LIVING
- Affiliated entity
- SIGNATURE HEALTHCARE
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Ira Smedra |
5% Or Greater Indirect Ownership Interest | Jul 1, 2016 | 12.03% |
| Jayson Allen |
W-2 Managing Employee |
Apr 17, 2023 | |
| SHC LP Holdings III, LLC |
5% Or Greater Direct Ownership Interest | Jul 1, 2016 | 55.5% |
| Spring Holdings, LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2016 | 100% |
| Mountain States Health Alliance |
5% Or Greater Indirect Ownership Interest | Dec 3, 2018 | 100% |
| Signature Healthcare LLC |
Other | May 7, 2018 | |
| Lpsnf LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2016 | 72.9% |
| John H Harrison |
Corporate Officer |
Jan 24, 2005 | |
| Wheaten LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2016 | 5.37% |
| Elmer Joseph Steier III |
5% Or Greater Indirect Ownership Interest |
Jul 1, 2016 | 20.22% |
| Blue Ridge Medical Management Corporation |
5% Or Greater Direct Ownership Interest | Dec 3, 2018 | 44.5% |
| Jjla LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2016 | 20.22% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190402000769 | TN | Part a Provider - Skilled Nursing Facility | 9638410616 | Practice locations: Johnson City, TN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | |||
| Nursing Facility/Intermediate Care Facility | 313M00000X | |||
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
401 Princeton Rd
Johnson City, TN 37601-2028
Mailing address
12201 Bluegrass Pkwy
Louisville, KY 40299-2361
Phone (502) 568-7800
Other names
- Princeton Transitional Care & Assisted Living
Other providers in Johnson City, TN
- Michelle L Lowe
- Jennifer Hale Lowell
- April D Lowery
- Alexandra Loyd
- Stephen D Loyd
- Sarah Luna
- Theresa F Lura
- David P Lurie
- Luxottica of America Inc.
- Taylor Lynch
All providers in Johnson City, TN · Skilled Nursing Facility in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.