Church Home Rehabilitation and Healthcare, LLC

Key facts

NPI: 1083901706
Entity type: Organization (NPI type 2)
Primary specialty: Skilled Nursing Facility 314000000X
License: 00140467A (GA)
Legal business name: CHURCH HOME REHABILITATION AND HEALTHCARE, LLC
Practice address: 2470 Hwy 41 North
Fort Valley, GA 31030
Phone: (478) 987-1239
Fax: (478) 988-8273
NPI assigned: Jul 1, 2011
Organization subpart: No

Authorized official

Name: Mrs. Kathy Gibbs, RN, LTC ADM.
Title: Administrator
Phone: (478) 987-1239

Owners & managing parties with NPI records 1

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

Dipenkumar Rameshchandra Patel, M.D. Family Medicine Physician · Macon, GA · NPI 1124407499

CMS ownership ADP OF THE SNF · OPERATIONAL/MANAGERIAL CONTROL

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Dipenkumar Rameshchandra Patel, M.D. Family Medicine Physician · Macon, GA · NPI 1124407499

NPD (past)

Affiliated clinicians 1

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

Dipenkumar Rameshchandra Patel, M.D. Family Medicine Physician · Macon, GA · NPI 1124407499

Care Compare affiliation Nursing home

Medicare Care Compare: Nursing home

Listed as: Church Home Rehabilitation and Healthcare CCN 115708
Overall star rating: ★★★★☆ 4 of 5
Health inspections: ★★★★☆ 4 of 5
Staffing: ★★★☆☆ 3 of 5
Quality measures: ★★★★☆ 4 of 5
Type: Medicare and Medicaid
Ownership: Non profit - Church related
Certified: Nov 1, 2005
Medicare certification status: Active (Provider of Services file)
Certified beds: 75 · 69.8 residents per day on average

Source: Medicare Care Compare, processed Aug 1, 2026.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
11D0263760	Church Home Rehabilitation & Healthcare, LLC 2470 Hwy 41 North, Fort Valley, GA 31030	Certificate of waiver	Aug 31, 2026

Medicare participation

Medicare fee-for-service enrollment: Enrolled in GA

Skilled nursing facility certification: CCN 115708

Legal name: CHURCH HOME REHABILITATION AND HEALTHCARE, LLC
Certification status: Active
Provider type (POS): Nursing home – SNF/NF dual certification
Participating since: Nov 1, 2005
Last certification: Mar 14, 2024
Beds: 75
Ownership / control type: Church Related
Organization structure: LLC · Non-profit
Incorporated: Aug 12, 2010 in GA
Enrollment address: 2470 US Highway 41 N
Fort Valley, GA 31030-8716
Nursing home name: CHURCH HOME REHABILITATION AND HEALTHCARE

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.

Name	Role	Since	Share
Dawn Dunbar Individual	Corporate Officer Executive Director	Nov 15, 2021
	Operational/Managerial Control	Nov 15, 2021
	Adp of the SNF	Nov 15, 2021
Individual	Adp of the SNF	Jun 30, 2017
Haley Johnson Individual	Operational/Managerial Control	Feb 28, 2022
Haley Johnson Individual	Adp of the SNF	Feb 28, 2022
Shenita Bray Individual	Operational/Managerial Control	Sep 27, 2023
Shenita Bray Individual	Adp of the SNF	Sep 27, 2023
Organization · Portland, OR LLC, Consulting firm	Adp of the SNF	Apr 18, 2025
Elizabeth Greenway Individual	Operational/Managerial Control	Jul 1, 2024
Elizabeth Greenway Individual	Adp of the SNF	Jul 1, 2024
Beth Fuchs Individual	Operational/Managerial Control	Nov 28, 2005
Beth Fuchs Individual	Adp of the SNF	Nov 28, 2005
Charles J Bishop Individual	Corporate Officer Chairman	Jul 1, 2011
	Corporate Director Chairman	Jul 1, 2011
	Operational/Managerial Control	Jul 1, 2011
Dipenkumar Rameshchandra Patel Individual	Operational/Managerial Control	Jul 1, 2022
Dipenkumar Rameshchandra Patel Individual	Adp of the SNF	Jul 1, 2022
Elwood Collier Individual	Corporate Officer Vice Chairman	Aug 12, 2010
	Corporate Director Vice Chairman	Aug 12, 2010
	Operational/Managerial Control	Jul 1, 2011
Benita Johnson Individual	Operational/Managerial Control	Aug 8, 2022
Benita Johnson Individual	Adp of the SNF	Aug 8, 2022
Christy S Padgett Individual	Operational/Managerial Control	Oct 22, 2014
Christy S Padgett Individual	Adp of the SNF	Oct 22, 2014
Christ'S Sanctified Holy Church, Inc. Organization · Perry, GA Corporation, Non-profit	5% Or Greater Direct Ownership Interest	Jul 1, 2011	100%
	Adp of the SNF	Jul 21, 2011
Jordan G Collier Individual	Corporate Officer Treasurer	Jul 1, 2023
	Corporate Director Treasurer	Jul 1, 2023
	Operational/Managerial Control	Jul 1, 2023
Organization · Macon, GA LLC, Consulting firm	Adp of the SNF	Apr 18, 2025
Glenn Smith Individual	Corporate Officer Chief Operating Officer	Jan 3, 2016
	Operational/Managerial Control	Jan 3, 2016
	Adp of the SNF	Jan 3, 2016
Michael Glenn Individual	Operational/Managerial Control	Jul 1, 2024
Michael Glenn Individual	Adp of the SNF	Jul 1, 2024
Lachantay Smith Individual	Operational/Managerial Control	Apr 8, 2024
Lachantay Smith Individual	Adp of the SNF	Apr 8, 2024
Robert E Reese Individual	Operational/Managerial Control	Mar 24, 2020
Robert E Reese Individual	Adp of the SNF	Mar 24, 2020
Frank Robuck Individual	Corporate Director Board Member	Aug 12, 2010
Frank Robuck Individual	Operational/Managerial Control	Jul 1, 2011
Tracy M Rogers Individual	Corporate Officer Secretary	Jul 1, 2016
	Corporate Director Secretary	Jul 1, 2016
	Operational/Managerial Control	Jul 1, 2016
Mariola Cosby Individual	Corporate Director Board Member	Jul 1, 2011
Mariola Cosby Individual	Operational/Managerial Control	Jul 1, 2011
Susan R Dent Individual	Operational/Managerial Control	Aug 1, 1989
Susan R Dent Individual	Adp of the SNF	Aug 1, 1989
Mackenzie Stroupe Individual	Operational/Managerial Control	Oct 18, 2023
Mackenzie Stroupe Individual	Adp of the SNF	Oct 18, 2023
Randall Walker Individual	Corporate Director Board Member	Jul 1, 2018
Randall Walker Individual	Operational/Managerial Control	Jul 1, 2018

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20110914000366	GA	Part a Provider - Skilled Nursing Facility	8628249174	Practice locations: Fort Valley, GA

National Provider Directory

Locations

2470 US Highway 41 N
Fort Valley, GA 31030
Phone (478) 987-1239

101 Willie Lee Pkwy
Ste 400
Warner Robins, GA 31088
Phone (478) 242-3880

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Skilled Nursing Facility	314000000X	00140467A	GA	Yes

Addresses

Primary practice location

2470 Hwy 41 North
Fort Valley, GA 31030

Mailing address

PO Box 1376
Perry, GA 31069-1376
Phone (478) 987-1239

Other providers in Fort Valley, GA

All providers in Fort Valley, GA · Skilled Nursing Facility in Georgia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 4, 2015. 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.

Verify at the official NPI Registry.