NPIMap

Organization Active NPI

Stevens Park Health and Rehabilitation Center LLC

  • Skilled Nursing Facility
  • Augusta, GA
National Provider Identifier
1154558690
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
1-121-1951 Issued in GA
Legal business name
STEVENS PARK HEALTH AND REHABILITATION CENTER LLC
Practice address
820 Stevens Creek Rd
Augusta, GA 30907-9251
Phone
(478) 621-2100
NPI assigned
Jun 11, 2009
Last updated
Sep 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Authorized official

Name
Tina Lane
Title
Administrator
Phone
(478) 737-0350

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 1-121-1951 GA Primary

Addresses

Primary practice location

820 Stevens Creek Rd
Augusta, GA 30907-9251

Mailing address

820 Stevens Creek Rd
Augusta, GA 30907-9251

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091209000679 GA Part A Provider - Skilled Nursing Facility 0042359721 Practice locations: Augusta, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154558690. Details of each certification follow.

Skilled nursing facility certification: CCN 115294

Legal name
STEVENS PARK HEALTH AND REHABILITATION CENTER LLC
Doing business as
STEVENS PARK HEALTH AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 6, 2009
Last certification
Feb 18, 2024
Beds
42
Ownership / control type
Other Nonprofit
Multi-facility organization
HEALTH SCHOLARSHIPS
Organization structure
LLCNon-profit
Incorporated
Feb 9, 2009 in GA
Enrollment address
820 Stevens Creek Rd
Augusta, GA 30907-9251
Nursing home name
STEVENS PARK HEALTH AND REHABILITATION
Affiliated entity
ETHICA HEALTH

Care Compare: Nursing home

Medicare Care Compare
Listed as
Stevens Park Health and RehabilitationCCN 115294 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Other
Certified
Oct 6, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4239.3 residents per day on average
Chain
Ethica Health50 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
11D1103010Stevens Park Health and Rehabilitation820 Stevens Creek Road, Augusta, GA 30907Certificate of waiverJul 30, 2027

National Provider Directory

National Provider Directory

Locations

820 Stevens Creek Rd
Augusta, GA 30907
Phone (706) 860-6622

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Stevens Park Health and Rehabilitation Center LLC Organization, Gray, GA Non-profit Adp of the SNF Mar 3, 2023
Paul a Cable Individual Corporate DirectorBoard Member Mar 14, 2003 100%
Ralph Parks Warnock Individual Corporate DirectorBoard Member Jun 23, 2020 100%
Organization, Macon, GA LLC, Non-profit Adp of the SNF Apr 15, 2025
Ronnie D Rollins Individual Corporate DirectorBoard Member Mar 14, 2003 100%
Dave a Ringer Individual Operational/Managerial Control Mar 1, 2025
Adp of the SNF Mar 1, 2025
Stasha Hubble Individual Operational/Managerial Control Mar 13, 2026
Kathryn Dennis Individual Corporate DirectorBoard Member Nov 17, 2015 100%
Organization, Hawkinsville, GA Corporation, Medical provider/supplier, Non-profit Adp of the SNF Apr 15, 2025
Individual Adp of the SNF Jan 1, 2025
Organization, Gray, GA LLC, Medical provider/supplier, Non-profit Adp of the SNF Apr 15, 2025
Clinical Services Inc Organization, Gray, GA Corporation, Management services company, Non-profit, Chain home office Operational/Managerial Control Sep 1, 2009
Adp of the SNF Apr 15, 2025
Community Health Systems Inc Organization, Macon, GA Corporation, Non-profit Indirect Ownership Interest Sep 1, 2009 100%
Health Scholarships Inc Organization, Gray, GA Corporation, Holding company, Non-profit, Owned by another organization or individual Direct Ownership Interest Sep 1, 2009 100%
Tina Lane Individual Operational/Managerial Control May 1, 2023
Adp of the SNF Apr 15, 2025
Kimberly C Hodges Individual Operational/Managerial Control Sep 1, 2023
Joseph a Wall Individual Corporate DirectorBoard Member Mar 14, 2003 100%
Joseph Nichols Individual Corporate DirectorBoard Member Nov 19, 2024 100%

Owners & managing parties with NPI records 2

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

Facilities with the same owner 49

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

View all 49

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1244678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695859200000",
    "number": "1154558690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 STEVENS CREEK RD",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309079251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 STEVENS CREEK RD",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309079251",
            "telephone_number": "478-621-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEVENS PARK HEALTH AND REHABILITATION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-11",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "478-737-0350"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "1-121-1951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.