Providence SNF Operator LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PROVIDENCE SNF OPERATOR LLC

Practice address

1011 S Green St
Thomaston, GA 30286-4643

Phone

(706) 647-6693

Fax

(706) 648-9255

NPI assigned

Jun 29, 2017

Last updated

Jul 21, 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

Bruce E Wertheim

Title

Manager

Phone

(813) 347-9888

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114448271. Details of each certification follow.

• CCN 115484 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 115484

Legal name

PROVIDENCE SNF OPERATOR LLC

Doing business as

PROVIDENCE HEALTHCARE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Oct 1, 1989

Last certification

Feb 25, 2024

Beds

110

Ownership / control type

Individual

Multi-facility organization

Beacon LLC

Organization structure

LLCProprietary

Incorporated

Jun 6, 2017 in FL

Enrollment address

1011 S Green St
Thomaston, GA 30286-4643

Nursing home name

PROVIDENCE HEALTHCARE

Affiliated entity

BEACON HEALTH MANAGEMENT

Listed as

Providence HealthcareCCN 115484 · All quality measures

Overall star rating

2 of 5

Health inspections

1 of 5

Staffing

1 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Individual

Certified

Oct 1, 1989

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

11074.6 residents per day on average

Chain

Beacon Health Management11 facilities in the chain

Abuse citation

Cited for abuse (Care Compare abuse icon)

Penalties (3 years)

1Fines totaling $0

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

All disclosed owners & managing parties 4

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

Facilities with the same owner 9

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

• Am SNF LLC

  dba Altamaha Healthcare Center

  • Skilled Nursing Facility
  • Jesup, GA
  • NPI 1487001343

  Beacon Health Management LLC, PWW Healthcare, LLC

  CMS ownership
• CL SNF LLC

  dba River Brook Healthcare Center

  • Skilled Nursing Facility
  • Homerville, GA
  • NPI 1831547314

  Beacon Health Management LLC, PWW Healthcare, LLC

  CMS ownership
• Cochran SNF Operator LLC

  dba Bryant Health and Rehabilitation Center

  • Skilled Nursing Facility
  • Cochran, GA
  • NPI 1306370267

  Beacon Health Management LLC, PWW Healthcare, LLC

  CMS ownership
• CV SNF LLC

  dba Crossview Care Center

  • Skilled Nursing Facility
  • Pineview, GA
  • NPI 1851757744

  Beacon Health Management LLC, PWW Healthcare, LLC

  CMS ownership
• FS SNF LLC

  dba Folkston Park Care and Rehabilitation Center

  • Skilled Nursing Facility
  • Folkston, GA
  • NPI 1467999573

  Beacon Health Management LLC, PWW Healthcare, LLC

  CMS ownership
• HZ SNF LLC

  dba Hazlehurst Court Care and Rehabilitation Center

  • Skilled Nursing Facility
  • Hazlehurst, GA
  • NPI 1851837934

  Beacon Health Management LLC, PWW Healthcare, LLC

  CMS ownership
• PW SNF LLC

  dba Pleasant View Nursing Center

  • Skilled Nursing Facility
  • Metter, GA
  • NPI 1790133114

  Beacon Health Management LLC, PWW Healthcare, LLC

  CMS ownership
• TN SNF LLC

  dba Tattnall Healthcare Center

  • Skilled Nursing Facility
  • Reidsville, GA
  • NPI 1518315936

  Beacon Health Management LLC, PWW Healthcare, LLC

  CMS ownership
• Wadley SNF Operator LLC

  dba Comfort Creek Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Wadley, GA
  • NPI 1255815304

  Beacon Health Management LLC

  CMS ownership

Practitioners 1

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.

• Jonathan Frank Busbee, M.D.

  • Internal Medicine Physician
  • Thomaston, GA
  • NPI 1346212792
  NPD (past)

Affiliated clinicians 1

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

• Jonathan Frank Busbee, M.D.

  • Internal Medicine Physician
  • Thomaston, GA
  • NPI 1346212792

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1498694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1114448271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 S GREEN ST",
            "city": "THOMASTON",
            "state": "GA",
            "postal_code": "302864643",
            "telephone_number": "706-647-6693",
            "fax_number": "706-648-9255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 S GREEN ST",
            "city": "THOMASTON",
            "state": "GA",
            "postal_code": "302864643",
            "telephone_number": "706-647-6693",
            "fax_number": "706-648-9255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE SNF OPERATOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-29",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WERTHEIM",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "813-347-9888"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Ruth Pinnow, MSW, LCSW
• Practice Equity, LLC (Douglas S. Johnson, DMD)
• Angelic J Prather, D.C.
• Providence Health and Rehabilitation Center, Inc.
• Providence Post Acute LLC
• Kendra Latrice Raines, APRN
• Rayneb Medical
• Red Clay Ventures, LLC (Thomaston Prescription Shop)
• Rehab Potential, LLC
• Richard Clayton D.C. P.C.

• Skilled Nursing Facility in Thomaston, GA
• Providers in Thomaston, GA by specialty
• Skilled Nursing Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.