LP Cookeville, LLC
Organization Active NPI Skilled Nursing Facility · Cookeville, TN
NPI 1144645870 · NPPES record last updated Apr 4, 2023
Key facts
- NPI
- 1144645870
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- LP COOKEVILLE, LLC
- Practice address
- 278 Dry Valley Rd
Cookeville, TN 38506-5461 - Phone
- (931) 537-6524
- Fax
- (931) 537-3013
- NPI assigned
- Mar 5, 2014
- Organization subpart
- No
Authorized official
- Name
- John Harrison
- Title
- Cfo
- Phone
- (502) 568-7800
Facilities with the same owner 67
Practitioners 1
-
James Darryl Richards, M.D.
Affiliated clinicians 3
-
Chet M Gentry, MD
-
Jane Anne Gotcher, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Signature Healthcare of Putnam County
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★★☆☆☆ 2 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Sep 29, 1980
- Medicare certification status
- Active
- Certified beds
- 175 · 139.4 residents per day on average
- Chain
- Signature Healthcare
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0316130 | LP Cookeville, LLC | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Skilled nursing facility certification: CCN 445136
- Legal name
- LP COOKEVILLE LLC
- Doing business as
- SIGNATURE HEALTHCARE OF PUTNAM COUNTY
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Sep 29, 1980
- Last certification
- May 18, 2023
- Beds
- 175
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Signature Healthcare
- Most recent change of ownership
- May 1, 2014
- Organization structure
- LLC · Proprietary
- Incorporated
- Feb 4, 2014 in DE
- Enrollment address
- 278 Dry Valley Rd
Cookeville, TN 38506-5461 - Nursing home name
- SIGNATURE HEALTHCARE OF PUTNAM COUNTY
- Affiliated entity
- SIGNATURE HEALTHCARE
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Paula S Boone |
W-2 Managing Employee |
Jan 16, 2023 | |
| Ira Smedra |
5% Or Greater Indirect Ownership Interest | May 1, 2014 | 12% |
| Asbr Holdings LLC |
5% Or Greater Indirect Ownership Interest | May 1, 2018 | 100% |
| Signature Healthcare LLC |
Other | May 1, 2014 | |
| SHC LP Holdings LLC |
5% Or Greater Direct Ownership Interest | May 1, 2014 | 100% |
| Lpsnf LLC |
5% Or Greater Indirect Ownership Interest | May 1, 2014 | 74% |
| John H Harrison |
Corporate Officer |
May 1, 2014 | |
| Wheaten LLC |
5% Or Greater Indirect Ownership Interest | May 1, 2014 | 5% |
| Elmer Joseph Steier III |
5% Or Greater Indirect Ownership Interest | May 1, 2014 | 20% |
| Jjla LLC |
5% Or Greater Indirect Ownership Interest | May 1, 2014 | 20% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140502000282 | TN | Part a Provider - Skilled Nursing Facility | 1052544897 | Practice locations: Cookeville, TN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | TN | Yes |
Addresses
Primary practice location
278 Dry Valley Rd
Cookeville, TN 38506-5461
Mailing address
278 Dry Valley Rd
Cookeville, TN 38506-5461
Phone (931) 537-6524
Other names
- Signature HealthCARE of Putnam County
Other providers in Cookeville, TN
- Anne Loubier
- Carole Lovell
- Lisa A Lovell
- Mark Lovell
- Sherrie Lynn Lowe
- Phillip H Lucas
- Shelby Leigh Ann Lucas
- Lucky Strike Medical Supply Inc
- Margarita Lundhom
- Tara Luther
All providers in Cookeville, TN · Skilled Nursing 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.