NPIMap

Organization Active NPI

Selectis Sparta LLC

Doing business as Providence of Sparta Health and Rehab

  • Skilled Nursing Facility
  • Sparta, GA
National Provider Identifier
1225608912
Registry record updated Jun 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SELECTIS SPARTA LLC
Doing business as
Providence of Sparta Health and Rehab
Practice address
60 Providence St
Sparta, GA 31087-1601
Phone
(706) 444-5153
Fax
(706) 444-8875
NPI assigned
Jun 25, 2021
Last updated
Jun 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2021

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

Authorized official

Name
Christopher R Barker
Title
Manager
Phone
(303) 449-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

60 Providence St
Sparta, GA 31087-1601

Mailing address

60 Providence St
Sparta, GA 31087-1601
Phone (706) 444-5153

Other names 1

  • Providence of Sparta Health and Rehab Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210806002409 GA Part A Provider - Skilled Nursing Facility 7113321522 Practice locations: Sparta, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225608912. Details of each certification follow.

Skilled nursing facility certification: CCN 115397

Legal name
SELECTIS SPARTA LLC
Doing business as
PROVIDENCE OF SPARTA HEALTH AND REHAB
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 1, 1989
Last certification
Aug 11, 2024
Beds
71
Ownership / control type
Corporation
Multi-facility organization
SELECTIS HEALTH, INC
Organization structure
LLCProprietary
Incorporated
Jan 28, 2021 in GA
Enrollment address
60 Providence St
Sparta, GA 31087-1601

Care Compare: Nursing home

Medicare Care Compare
Listed as
Woods at Sparta of Journey LLC, TheCCN 115397 · All quality measures
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Sep 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7140.2 residents per day on average
Penalties (3 years)
2Fines totaling $13,325

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Adam a Desmond Individual Corporate DirectorBoard of Directors Member of Sel Jun 21, 2021
Brandon L Thall Individual Corporate OfficerCfo of Selectis Health Inc Jun 21, 2021
Selectis Management LLC Organization, Greenwood Village, CO LLC, For-profit Operational/Managerial Control Jun 21, 2021
Zvi Rhine Individual 5% Or Greater Indirect Ownership Interest Jun 21, 2021 6.5%
Lance Baller Individual 5% Or Greater Indirect Ownership Interest Jun 21, 2021 9.32%
Corporate OfficerCeo of Selectis Health Inc Jun 21, 2021
Corporate DirectorChairman of the Board of Selecti Jun 21, 2021
Operational/Managerial ControlManager of Selectis Management L Jun 21, 2021
Rhonda J Ross Individual Operational/Managerial ControlOperations Director Jun 21, 2021
Selectis Health Inc Organization, Greenwood Village, CO Corporation, For-profit 5% Or Greater Direct Ownership Interest Jun 21, 2021 100%
Krystal D Eckhart Individual Operational/Managerial ControlRegional Business Office Manager Jun 21, 2021
Peterson Mirville Individual W-2 Managing EmployeeAdministrator Jun 21, 2021 100%
Christopher Randolph Barker Individual Corporate OfficerCoo of Selectis Health, Inc Jun 21, 2021
Corporate DirectorPresident/Board Member of Select Jun 21, 2021
Operational/Managerial ControlManager of Selectis Management L Jun 21, 2021

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1624579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624579200000",
    "number": "1225608912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 PROVIDENCE ST",
            "city": "SPARTA",
            "state": "GA",
            "postal_code": "310871601",
            "telephone_number": "706-444-5153",
            "fax_number": "706-444-8875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 PROVIDENCE ST",
            "city": "SPARTA",
            "state": "GA",
            "postal_code": "310871601",
            "telephone_number": "706-444-5153",
            "fax_number": "706-444-8875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELECTIS SPARTA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-25",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A",
        "authorized_official_last_name": "BARKER",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "303-449-2100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence of Sparta Health and Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sparta, GA

Sources for this page

Verify at the official NPI Registry.