CHC Heritage Square Nursing Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CHC HERITAGE SQUARE NURSING CENTER, LLC

Doing business as

Heritage Square Healthcare Center

Practice address

710 N Ruddle Rd
Blytheville, AR 72315-2137

Phone

(870) 763-3654

Fax

(870) 762-1172

NPI assigned

Sep 14, 2018

Last updated

Oct 4, 2024By 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

Boyd Wright

Title

Ceo

Phone

(870) 347-0001

Specialties & licenses 1

Addresses

Other names 1

• Heritage Square Healthcare Center Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205319340. Details of each certification follow.

• CCN 045366 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 045366

Legal name

CHC HERITAGE SQUARE NURSING CENTER, LLC

Doing business as

HERITAGE SQUARE HEALTHCARE CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Apr 19, 2001

Last certification

May 8, 2025

Beds

86

Ownership / control type

Limited Liability Corporation

Multi-facility organization

Credence Healthcare

Most recent change of ownership

Nov 1, 2018

Organization structure

LLCProprietary

Incorporated

Aug 28, 2018 in AR

Enrollment address

710 N Ruddle Rd
Blytheville, AR 72315-2137

Nursing home name

HERITAGE SQUARE HEALTHCARE CENTER

Listed as

Heritage Square Healthcare CenterCCN 045366 · All quality measures

Overall star rating

4 of 5

Health inspections

4 of 5

Staffing

3 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Apr 19, 2001

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

8675.5 residents per day on average

Penalties (3 years)

1Fines totaling $7,913

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

Locations

All disclosed owners & managing parties 13

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

Owners & managing parties with NPI records 1

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

• Mark S Hahn, DO

  • Family Medicine Physician
  • Caraway, AR
  • NPI 1609895911

  Adp of the SNF

  CMS ownership

Facilities with the same owner 5

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

• CHC Gosnell Health and Rehab, LLC

  dba Gosnell Health and Rehab

  • Skilled Nursing Facility
  • Gosnell, AR
  • NPI 1386127488

  Pharmacy Consults, LLC

  CMS ownership
• CHC Lakeside Nursing Center, LLC

  dba Lakeside Health and Rehab

  • Skilled Nursing Facility
  • Lake City, AR
  • NPI 1447733480

  BWDV Holdings, LLC, Care Systems, LLC, Credence Health Care, LLC, Pharmacy Consults, LLC

  CMS ownership
• CHC Manila Nursing Center, LLC

  dba Manila Healthcare Center

  • Skilled Nursing Facility
  • Manila, AR
  • NPI 1053894097

  BWDV Holdings, LLC, Credence Health Care, LLC, Pharmacy Consults, LLC

  CMS ownership
• Trumman Ops, Inc.

  dba Quail Run Health and Rehab

  • Skilled Nursing Facility
  • Trumann, AR
  • NPI 1104469527

  Pharmacy Consults, LLC

  CMS ownership
• WRNC Inc

  dba Chapel Woods Health and Rehabilitation

  • Skilled Nursing Facility
  • Warren, AR
  • NPI 1477897130

  Pharmacy Consults, LLC

  CMS ownership

Affiliated clinicians 1

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

• Mark S Hahn, DO

  • Family Medicine Physician
  • Caraway, AR
  • NPI 1609895911

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1536883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728000000000",
    "number": "1205319340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 HIGHWAY 64 E STE D",
            "city": "AUGUSTA",
            "state": "AR",
            "postal_code": "720065158",
            "telephone_number": "870-347-0001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 N RUDDLE RD",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723152137",
            "telephone_number": "870-763-3654",
            "fax_number": "870-762-1172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHC HERITAGE SQUARE NURSING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-14",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "BOYD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-347-0001"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Heritage Square Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Zeb Freeman Carnes, D.D.S.
• Kelly Carter
• Tracy Dawn Caskey, BS, MHPP
• Ma Cedeno
• Rachael Chandler, NP
• Lisa L Chew, MHPP
• Sharonda N Chew, NURSE
• City Cab Inc
• Meshia Clark
• Brittany Elizabeth Clayton

• Skilled Nursing Facility in Blytheville, AR
• Providers in Blytheville, AR by specialty
• Skilled Nursing Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; 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.