LP Rogersville LLC
Organization Active NPI Nursing Facility/Intermediate Care Facility · Rogersville, TN
NPI 1104017490 · NPPES record last updated Apr 4, 2023
Key facts
- NPI
- 1104017490
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nursing Facility/Intermediate Care Facility 313M00000X
- License
- 124 (TN)
- Legal business name
- LP ROGERSVILLE LLC
- Practice address
- 109 Highway 70 N
Rogersville, TN 37857-4001 - Phone
- (423) 272-3099
- Fax
- (423) 272-6591
- NPI assigned
- Aug 5, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- LP CR HOLDINGS LLC
Authorized official
- Name
- Mr. John Harrison
- Title
- Cfo
- Phone
- (502) 568-7800
Facilities with the same owner 64
Practitioners 2
Affiliated clinicians 1
Medicare Care Compare: Nursing home
- Listed as
- Signature Healthcare of Rogersville
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★★★ 5 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Sep 1, 1995
- Medicare certification status
- Active
- Certified beds
- 150 · 87.7 residents per day on average
- Chain
- Signature Healthcare
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0659232 | LP Rogersville LLC | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Skilled nursing facility certification: CCN 445359
- Legal name
- LP ROGERSVILLE LLC
- Doing business as
- SIGNATURE HEALTHCARE OF ROGERSVILLE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Sep 1, 1995
- Last certification
- Sep 8, 2022
- Beds
- 150
- Ownership / control type
- Corporation
- Multi-facility organization
- Signature Healthcare
- Organization structure
- LLC · Proprietary
- Incorporated
- Nov 8, 2006 in DE
- Enrollment address
- 109 Highway 70 N
Rogersville, TN 37857-4001 - Nursing home name
- SIGNATURE HEALTHCARE OF ROGERSVILLE
- Affiliated entity
- SIGNATURE HEALTHCARE
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Jessica Shelton |
W-2 Managing Employee |
Aug 19, 2024 | |
| Ira Smedra |
5% Or Greater Indirect Ownership Interest | Nov 1, 2007 | 12% |
| Agemo Holdings LLC |
5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 100% |
| Lpsnf II LLC |
5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 74% |
| Signature Healthcare LLC |
Other | Nov 1, 2007 | |
| John H Harrison |
Corporate Officer |
Nov 1, 2007 | |
| Wheaten LLC |
5% Or Greater Indirect Ownership Interest | Nov 1, 2007 | 5% |
| Elmer Joseph Steier III |
5% Or Greater Indirect Ownership Interest | Nov 1, 2007 | 20% |
| LP CR Holdings LLC |
5% Or Greater Direct Ownership Interest | Nov 1, 2007 | 100% |
| Jjla LLC |
5% Or Greater Indirect Ownership Interest | Nov 1, 2007 | 20% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071018000286 | TN | Part a Provider - Skilled Nursing Facility | 3476649799 | Practice locations: Rogersville, TN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | 124 | TN | Yes |
| Skilled Nursing Facility | 314000000X | 124 | TN |
Addresses
Primary practice location
109 Highway 70 N
Rogersville, TN 37857-4001
Mailing address
12201 Bluegrass Parkway
Louisville, KY 40299-2361
Phone (502) 568-7800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7440320 | Medicaid | TN | |
| 0445359 | Medicaid | TN |
Other names
- Signature HealthCARE of Rogersville
NPI Registry JSON
{
"created_epoch": "1186272000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1680566400000",
"number": "1104017490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12201 BLUEGRASS PARKWAY",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402992361",
"telephone_number": "502-568-7800",
"fax_number": "502-568-7150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 HIGHWAY 70 N",
"city": "ROGERSVILLE",
"state": "TN",
"postal_code": "378574001",
"telephone_number": "423-272-3099",
"fax_number": "423-272-6591"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LP ROGERSVILLE LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "LP CR HOLDINGS LLC",
"enumeration_date": "2007-08-05",
"last_updated": "2023-04-04",
"certification_date": "2023-04-04",
"status": "A",
"authorized_official_last_name": "HARRISON",
"authorized_official_first_name": "JOHN",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "502-568-7800",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "313M00000X",
"taxonomy_group": "",
"desc": "Nursing Facility/Intermediate Care Facility",
"state": "TN",
"license": "124",
"primary": true
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "TN",
"license": "124",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7440320",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0445359",
"state": "TN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Signature HealthCARE of Rogersville",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Signature HealthCARE of Rogersville",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Rogersville, TN
- Micah David Lawson
- Amy Nicole Lipe
- Geraldine D Livermore
- Andrew Long
- Looking Forward Counseling, LLC
- Keshia Beth Luster
- Reghan W Maddox
- Connie A Manz Hinkle
- Brandt Marinelli
- Brenda A Martinez
All providers in Rogersville, TN · Nursing Facility/Intermediate Care 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 Apr 4, 2023. 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.