CLC of Ripley, LLC
Organization Active NPI Skilled Nursing Facility · Ripley, TN
NPI 1366432031 · NPPES record last updated Jan 28, 2008
Key facts
- NPI
- 1366432031
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 0000000154 (TN)
- Legal business name
- CLC OF RIPLEY, LLC
- Practice address
- 215 Lackey LN
Ripley, TN 38063-1619 - Phone
- (731) 635-5100
- Fax
- (731) 635-5184
- NPI assigned
- Oct 25, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Douglas M. Wright Jr.
- Title
- Managing Member
- Phone
- (662) 680-3148
Owners & managing parties with NPI records 1
-
Tanveer Aslam, MD
Facilities with the same owner 16
Practitioners 1
-
Tanveer Aslam, MD
Affiliated clinicians 1
-
Tanveer Aslam, MD
Medicare Care Compare: Nursing home
- Listed as
- Lauderdale Community Living Center
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Aug 1, 1995
- Medicare certification status
- Active
- Certified beds
- 71 · 32.6 residents per day on average
- Chain
- Community Eldercare Services
- Penalties (3 years)
- 2 · fines totaling $43,644
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0670181 | Lauderdale Community Living Center | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Skilled nursing facility certification: CCN 445354
- Legal name
- CLC OF RIPLEY LLC
- Doing business as
- LAUDERDALE COMMUNITY LIVING CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 1, 1995
- Last certification
- Jun 12, 2024
- Beds
- 71
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Community Eldercare Services
- Organization structure
- LLC · Proprietary
- Incorporated
- Oct 12, 2000 in TN
- Enrollment address
- 215 Lackey LN
Ripley, TN 38063-1619 - Nursing home name
- LAUDERDALE COMMUNITY LIVING CENTER
- Affiliated entity
- COMMUNITY ELDERCARE SERVICES
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Tanveer Aslam |
Operational/Managerial Control | Jan 1, 2023 | |
| Adp of the SNF | Jan 1, 2026 | ||
| Community Living Centers, LLC |
5% Or Greater Direct Ownership Interest | Nov 1, 2000 | 100% |
| Adp of the SNF | Jan 1, 2026 | ||
| Community Eldercare Services, LLC |
Operational/Managerial Control | Apr 1, 2000 | |
| Adp of the SNF | Jan 1, 2026 | ||
| Betty Edwards |
Operational/Managerial Control | Jun 16, 2025 | |
| Adp of the SNF | Jun 16, 2025 | ||
| Douglas Wright |
5% Or Greater Indirect Ownership Interest |
Nov 1, 2000 | 100% |
| Operational/Managerial Control | Apr 1, 2000 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051017000068 | TN | Part a Provider - Skilled Nursing Facility | 8123044500 | Practice locations: Ripley, TN |
National Provider Directory
Locations
215 Lackey Ln
Ripley, TN 38063
Phone (731) 635-5100
210 Tucker Ave
Ripley, TN 38063
Phone (901) 635-5100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 0000000154 | TN | Yes |
Addresses
Primary practice location
215 Lackey LN
Ripley, TN 38063-1619
Mailing address
215 Lackey LN
Ripley, TN 38063-1619
Phone (731) 635-5100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 744-0559 | Medicaid | TN |
Other names
- Lauderdale Community Living Center
Other providers in Ripley, TN
- Christian Family Medicine
- Christian Family Medicine, LLC
- Christian Family Pharmacy LLC
- Annabelle Chua
- Citizens of Lake County for Health Care, Inc
- James R Coffman
- Lauren Conatser
- Cedric Cooper
- Crain'S Pharmacy Inc
- Crossriver Telehealth PLLC
All providers in Ripley, TN · Skilled Nursing Facility in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2008. 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.