Shadescrest Health Care Center

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

10671 Issued in AL

Legal business name

SHADESCREST HEALTH CARE CENTER

Practice address

331 25TH St W
Jasper, AL 35501-5828

Phone

(205) 384-9086

Fax

(205) 387-2225

NPI assigned

Oct 5, 2005

Last updated

Jan 19, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Joe B Havens

Title

Administrator

Phone

(205) 384-9086

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073500831. Details of each certification follow.

• CCN 015114 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 015114

Legal name

SHADESCREST HEALTH CARE CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Dec 29, 1970

Last certification

Feb 9, 2024

Beds

107

Ownership / control type

Individual

Organization structure

CorporationProprietary

Incorporated

Jan 1, 1971 in AL

Enrollment address

331 25TH St W
Jasper, AL 35501-5828

Nursing home name

SHADESCREST HEALTH CARE CENTER

Listed as

Shadescrest Health Care CenterCCN 015114 · All quality measures

Overall star rating

1 of 5

Health inspections

1 of 5

Staffing

4 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Individual

Certified

Dec 29, 1970

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

10797.1 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Locations

All disclosed owners & managing parties 25

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Boyde J Harrison, MD

  • Family Medicine Physician
  • Haleyville, AL
  • NPI 1619908571

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

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.

• Boyde J Harrison, MD

  • Family Medicine Physician
  • Haleyville, AL
  • NPI 1619908571
  NPD (past)
• Erald Lula

  • Internal Medicine Physician
  • Hoover, AL
  • NPI 1790246098
  NPD (past)
• Allen Sanyi, DO

  • Internal Medicine Physician
  • Jasper, AL
  • NPI 1114556271
  NPD (past)

Affiliated clinicians 2

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

• Boyde J Harrison, MD

  • Family Medicine Physician
  • Haleyville, AL
  • NPI 1619908571

  Nursing home

  Care Compare affiliation
• Allen Sanyi, DO

  • Internal Medicine Physician
  • Jasper, AL
  • NPI 1114556271

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642550400000",
    "number": "1073500831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 25TH ST W",
            "address_2": "P.O. BOX 1012",
            "city": "JASPER",
            "state": "AL",
            "postal_code": "355015828",
            "telephone_number": "205-384-9086",
            "fax_number": "205-387-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 25TH ST W",
            "city": "JASPER",
            "state": "AL",
            "postal_code": "355015828",
            "telephone_number": "205-384-9086",
            "fax_number": "205-387-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADESCREST HEALTH CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A",
        "authorized_official_last_name": "HAVENS",
        "authorized_official_first_name": "JOE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "205-384-9086",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AL",
            "license": "10671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4754101S",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peter Strom Selikoff, M.D.
• Richard Anthony Sellers, ALC06191
• Emily Ivey Sentell, CCC-SLP
• Richard Daryl Shackleford, LMT
• Shades Valley Dermatology, LLC
• Cassidy Shadinger, PHARMD
• Mohammed Sharif
• Jennifer Shay, LMSW
• Teresa Hindman Sherer, PHARM. D.
• Rachel Leanna Shewbart, M.S., CCC-SLP

• Skilled Nursing Facility in Jasper, AL
• Providers in Jasper, AL by specialty
• Skilled Nursing Facility in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.