Bolivar Operator LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

171 Issued in TN

Legal business name

BOLIVAR OPERATOR LLC

Practice address

700 Nuckolls Rd
Bolivar, TN 38008-1531

Phone

(731) 658-4707

Fax

(731) 658-4769

NPI assigned

Nov 13, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Stacey Paul Rogers

Title

Chief Financial Officer

Phone

(502) 429-8062

Specialties & licenses 1

Addresses

Other names 2

• Pine Meadows Healthcare Doing business as
• Pine Meadows Healthcare and Rehabilitation Center Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Skilled nursing facility certification: CCN 445232

Legal name

BOLIVAR OPERATOR LLC

Doing business as

PINE MEADOWS HEALTHCARE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Sep 6, 1989

Last certification

Jun 10, 2021

Beds

134

Ownership / control type

Corporation

Multi-facility organization

Prestige Healthcare

Most recent change of ownership

Feb 1, 2007

Organization structure

LLCProprietary

Incorporated

Nov 2, 2006 in DE

Enrollment address

700 Nuckolls Rd
Bolivar, TN 38008-1531

Nursing home name

PINE MEADOWS HEALTH CARE

Affiliated entity

PRESTIGE ADMINISTRATIVE SERVICES

Listed as

Pine Meadows Health CareCCN 445232

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

2 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Sep 6, 1989

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

13499.3 residents per day on average

Chain

Prestige Administrative Services9 facilities in the chain

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

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.

Facilities with the same owner 77

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

• Bartlett Operator, LLC

  • Skilled Nursing Facility
  • Bartlett, TN
  • NPI 1780160408

  B&Y Healthcare S Corp, B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Northpoint Regional LLC, Prestige Administrative Services, LLC

  CMS ownership
• Blounts Operator LLC

  • Skilled Nursing Facility
  • Blountville, TN
  • NPI 1356413843

  B&Y Healthcare S Corp, B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Northpoint Regional LLC, Prestige Administrative Services, LLC

  CMS ownership
• Camden Operator LLC

  • Skilled Nursing Facility
  • Camden, TN
  • NPI 1871664649

  B&Y Healthcare S Corp, B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Northpoint Regional LLC, Prestige Administrative Services, LLC

  CMS ownership
• Hunting Operator LLC

  • Skilled Nursing Facility
  • Huntingdon, TN
  • NPI 1568533206

  B&Y Healthcare S Corp, B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Northpoint Regional LLC, Prestige Administrative Services, LLC

  CMS ownership
• Jefferson Operator LLC

  • Skilled Nursing Facility
  • Jefferson City, TN
  • NPI 1376614164

  B&Y Healthcare S Corp, B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Northpoint Regional LLC, Prestige Administrative Services, LLC

  CMS ownership
• Memphis Operator LLC

  • Skilled Nursing Facility
  • Memphis, TN
  • NPI 1821169517

  B&Y Healthcare S Corp, B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Northpoint Regional LLC, Prestige Administrative Services, LLC

  CMS ownership
• Ripley Operator LLC

  • Skilled Nursing Facility
  • Ripley, TN
  • NPI 1780758755

  B&Y Healthcare S Corp, B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Northpoint Regional LLC, Prestige Administrative Services, LLC

  CMS ownership
• Alpena Opco LLC

  • Skilled Nursing Facility
  • Alpena, MI
  • NPI 1891211264

  B&Y Healthcare S Corp, B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Prestige Administrative Services, LLC

  CMS ownership
• Capital Area Opco LLC

  • Skilled Nursing Facility
  • Lansing, MI
  • NPI 1528465739

  B&Y Healthcare S Corp, B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Prestige Administrative Services, LLC

  CMS ownership
• Carroll Opco, LLC

  • Skilled Nursing Facility
  • Carroll, OH
  • NPI 1528466471

  B&Y Healthcare S Corp, B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Prestige Administrative Services, LLC

  CMS ownership
• Cass City Opco LLC

  • Skilled Nursing Facility
  • Cass City, MI
  • NPI 1316344526

  B&Y Healthcare S Corp, B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Prestige Administrative Services, LLC

  CMS ownership
• Cheboygan Opco LLC

  • Skilled Nursing Facility
  • Cheboygan, MI
  • NPI 1295251676

  B&Y Healthcare S Corp, B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Prestige Administrative Services, LLC

  CMS ownership

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samuel Olaniyi Bada, M.D.

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1770530586
  NPD (past)
• Evanna Proctor, MD

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1275500274
  NPD (past)

Affiliated clinicians 2

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

• Samuel Olaniyi Bada, M.D.

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1770530586

  Nursing home

  Care Compare affiliation
• Evanna Proctor, MD

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1275500274

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586736000000",
    "number": "1316018286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 NEW LA GRANGE RD",
            "address_2": "SUITE #100",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402224870",
            "telephone_number": "502-429-8062",
            "fax_number": "502-429-0650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 NUCKOLLS RD",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380081531",
            "telephone_number": "731-658-4707",
            "fax_number": "731-658-4769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLIVAR OPERATOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2020-04-13",
        "certification_date": "2020-04-13",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "502-429-8062",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Meadows Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pine Meadows Healthcare and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bolivar General Hospital, Inc.
• Bolivar General Hospital, Inc.
• Bolivar General Hospital, Inc.
• Bolivar Health & Rehabilitation LLC
• Bolivar Medical Clinic
• Ethel Annette Bowker, RNES
• Lafonda Boyd, BLS
• Mary Brinkley, C.O.T.A.
• Samantha Elizabeth Brock
• Brown Behavioral Health Services

• All providers in Bolivar, TN
• Skilled Nursing Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2020; 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.