2ND Generation Healthcare, LLC
Organization Active NPI Skilled Nursing Facility · Columbia, MS
NPI 1184902686 · NPPES record last updated Jun 1, 2018
Key facts
- NPI
- 1184902686
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 461 (MS)
- Legal business name
- 2ND GENERATION HEALTHCARE, LLC
- Practice address
- 11 Pecan Dr
Columbia, MS 39429 - Phone
- (601) 736-4747
- NPI assigned
- Aug 1, 2011
- Organization subpart
- No
Authorized official
- Name
- Michael Allan Bradshaw
- Title
- Member
- Phone
- (601) 736-4747
Corporate family (same tax ID) 1
Practitioners 2
-
Judd M Reynolds, D.O.
Affiliated clinicians 1
Medicare Care Compare: Nursing home
- Listed as
- The Grove
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★☆☆☆☆ 1 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jan 1, 2006
- Medicare certification status
- Active
- Certified beds
- 86 · 81.0 residents per day on average
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Skilled nursing facility certification: CCN 255316
- Legal name
- 2ND GENERATION HEALTHCARE LLC
- Doing business as
- THE GROVE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 2006
- Last certification
- Aug 29, 2024
- Beds
- 86
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- Jan 1, 2010 in MS
- Enrollment address
- 11 Pecan Dr
Columbia, MS 39429-2600 - Nursing home name
- THE GROVE
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Michael Bradshaw |
5% Or Greater Direct Ownership Interest | Oct 1, 2022 | 100% |
| Operational/Managerial Control | Jun 9, 2026 | 100% | |
| Adp of the SNF | Oct 1, 2012 | ||
| |
Adp of the SNF | Aug 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111219000964 | MS | Part a Provider - Skilled Nursing Facility | 5496920571 | Practice locations: Columbia, MS |
National Provider Directory
- Tax ID family
- 2ND Generation Healthcare LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 461 | MS | Yes |
Addresses
Primary practice location
11 Pecan Dr
Columbia, MS 39429
Mailing address
11 Pecan Dr
Columbia, MS 39429-2600
Phone (601) 736-4747
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00023026 | Medicaid | MS |
Other providers in Columbia, MS
- 2ND Generation Healthcare, LLC
- A1 Transit of Mississippi LLC
- Valerie Aikens
- Allison Leanne Albritton
- Reshonda Latoya Alford
All providers in Columbia, MS · Skilled Nursing Facility in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2018. 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.