NPIMap

Organization Active NPI

Lutheran Home - Wilmington, Inc.

Doing business as Trinity Grove

  • Skilled Nursing Facility
  • Wilmington, NC
National Provider Identifier
1194028118
Registry record updated Feb 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LUTHERAN HOME - WILMINGTON, INC.
Doing business as
Trinity Grove
Practice address
631 Junction Creek Drive
Wilmington, NC 28412-2296
Phone
(910) 465-6861
Fax
(910) 799-6564
NPI assigned
Dec 14, 2010
Last updated
Feb 4, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
LUTHERAN SERVICES FOR THE AGING, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 4, 2026

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

Authorized official

Name
Mrs. Deborah Ann Mathis
Title
Coo
Phone
(704) 637-2870

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

631 Junction Creek Drive
Wilmington, NC 28412-2296

Mailing address

1416 S Martin Luther King Jr Ave
PO Box 947
Salisbury, NC 28144-5592
Phone (704) 637-2870

Other names 1

  • Trinity Grove Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110222000205 NC Part A Provider - Skilled Nursing Facility 6406037605 Practice locations: Wilmington, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194028118. Details of each certification follow.

Skilled nursing facility certification: CCN 345554

Legal name
LUTHERAN HOME - WILMINGTON, INC.
Doing business as
TRINITY GROVE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 29, 2011
Last certification
Oct 10, 2024
Beds
100
Ownership / control type
Church Related
Multi-facility organization
Lutheran Services Carolinas
Organization structure
CorporationProprietary
Incorporated
Apr 30, 2007 in NC
Enrollment address
631 Junction Creek Drive
Wilmington, NC 28412-2296
Nursing home name
TRINITY GROVE
Affiliated entity
LUTHERAN SERVICES CAROLINAS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Trinity GroveCCN 345554 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Church related
Certified
Jun 29, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10094.9 residents per day on average
Chain
Lutheran Services Carolinas9 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
4Fines totaling $102,910

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
34D2035639Lutheran Home - Wilmington Dba Trinity Grove631 Junction Creek Drive, Wilmington, NC 28412Certificate of waiverJan 22, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Kesha L Smith Individual Corporate DirectorChief Operating Officer Sep 8, 2003
Operational/Managerial Control Oct 1, 2012
Richard Herman Individual Managing Control - Governing BodyTrustee Vice Chair Jun 1, 2021
Trustee of the SNF Jun 1, 2021
Ted W Goins Individual Operational/Managerial Control Nov 4, 2004
Managing Control - Governing BodyPresident Nov 4, 2004
Trustee of the SNF Nov 4, 2004
Adp of the SNF Nov 4, 2004
Lutheran Home Wilmington Property, Inc Organization, Salisbury, NC Corporation, Non-profit Operational/Managerial Control Apr 5, 1988
Adp of the SNF Apr 14, 2025
Douglas E Nelson Individual Managing Control - Governing BodyBoard Chair Sep 1, 2022
Trustee of the SNF Sep 1, 2022
Audrey L Sutton-Surak Individual Operational/Managerial Control Feb 25, 2022
Adp of the SNF Oct 1, 2012
Karen Maddry Individual Corporate OfficerSecretary Apr 30, 2007
Lutheran Services for the Aging, Inc. Organization, Salisbury, NC Corporation, Non-profit 5% Or Greater Direct Ownership Interest Apr 30, 2007 100%
Operational/Managerial Control Apr 30, 2007
Trustee of the SNF Apr 30, 2007
Adp of the SNF Apr 25, 2025
James Parrish Individual Operational/Managerial Control Feb 25, 2022
Adp of the SNF Feb 25, 2022
Kirby Nickerson Individual Corporate OfficerCfo Oct 1, 2012
Adp of the SNF Oct 1, 2012
Lsa Management, Inc. Organization, Salisbury, NC Corporation Operational/Managerial Control Apr 30, 2007
Adp of the SNF Mar 16, 2025

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 8

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

Practitioners & affiliated clinicians

Affiliated clinicians 9

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": "1292284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770163200000",
    "number": "1194028118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1416 S MARTIN LUTHER KING JR AVE",
            "address_2": "PO BOX 947",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281445592",
            "telephone_number": "704-637-2870",
            "fax_number": "910-799-6564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 JUNCTION CREEK DRIVE",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284122296",
            "telephone_number": "910-465-6861",
            "fax_number": "910-799-6564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN HOME - WILMINGTON, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LUTHERAN SERVICES FOR THE AGING, INC.",
        "enumeration_date": "2010-12-14",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A",
        "authorized_official_last_name": "MATHIS",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "704-637-2870",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trinity Grove",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.