NPIMap

Organization Active NPI

Collierville Nursing and Rehabilitation LLC

  • Skilled Nursing Facility
  • Collierville, TN
National Provider Identifier
1114400975
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
COLLIERVILLE NURSING AND REHABILITATION LLC
Practice address
490 W Poplar Ave
Collierville, TN 38017-2538
Phone
(901) 854-8506
NPI assigned
Sep 7, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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

Authorized official

Name
Mick Vujanovic
Title
Ceo
Phone
(502) 667-8150

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary
Respite Care 385H00000X

Addresses

Primary practice location

490 W Poplar Ave
Collierville, TN 38017-2538

Mailing address

2100 Cherokee Ridge Way Ste 100
Louisville, KY 40205-1600
Phone (502) 667-8150

Other names 1

  • Collierville Nursing and Rehabilitation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190102000365 TN Part A Provider - Skilled Nursing Facility 1254685878 Practice locations: Collierville, TN

Skilled nursing facility certification: CCN 445495

Legal name
COLLIERVILLE NURSING AND REHABILITATION LLC
Doing business as
COLLIERVILLE NURSING AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 7, 2009
Last certification
Feb 25, 2022
Beds
114
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
Oct 13, 2018
Organization structure
LLCProprietary
Incorporated
Jul 30, 2018 in TN
Enrollment address
490 W Poplar Ave
Collierville, TN 38017-2538
Nursing home name
COLLIERVILLE NURSING AND REHABILITATION, LLC
Affiliated entity
SIMCHA HYMAN & NAFTALI ZANZIPER

Care Compare: Nursing home

Medicare Care Compare
Listed as
Collierville Nursing And Rehabilitation, LlcCCN 445495
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 7, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
11496.3 residents per day on average
Chain
Simcha Hyman & Naftali Zanziper79 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D0679770Collierville Nursing and Rehabilitation LLC490 West Poplar Avenue, Collierville, TN 38017Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Collierville Nursing and Rehabilitation LLC Organization, Collierville, TN Created for acquisition, LLC, Medical provider/supplier, For-profit 5% Or Greater Direct Ownership Interest Oct 13, 2018 100%
Simcha Melech Hyman Individual 5% Or Greater Indirect Ownership InterestOwner Oct 13, 2018 50%
Mick Vujanovic Individual Operational/Managerial ControlCeo Oct 12, 2018
Adp of the SNF Oct 12, 2018
Kenneth Crowdus Individual Operational/Managerial Control Feb 9, 2026
Adp of the SNF Feb 9, 2026
Naftali Zanziper Individual 5% Or Greater Indirect Ownership InterestOwner Oct 13, 2018 50%
Mohamad K Moughrabieh Individual Operational/Managerial Control Jan 1, 2022
Managing Control - Governing BodyMedical Director Jan 1, 2022
Adp of the SNF Jan 1, 2022
Clearview Healthcare Management TN LLC Organization, Louisville, KY LLC, Management services company, For-profit Operational/Managerial Control Oct 12, 2018
Adp of the SNF Jun 23, 2026

Owners & managing parties with NPI records 1

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

Facilities with the same owner 9

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

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1536278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728432000000",
    "number": "1114400975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 CHEROKEE RIDGE WAY STE 100",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402051600",
            "telephone_number": "502-667-8150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 W POPLAR AVE",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380172538",
            "telephone_number": "901-854-8506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIERVILLE NURSING AND REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-07",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A",
        "authorized_official_last_name": "VUJANOVIC",
        "authorized_official_first_name": "MICK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "502-667-8150"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collierville Nursing and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Collierville, TN

Sources for this page

Verify at the official NPI Registry.