Lutheran Home of Southbury Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

699C Issued in CT

Legal business name

LUTHERAN HOME OF SOUTHBURY INC

Practice address

990 Main St N
Southbury, CT 06488-1267

Phone

(203) 264-9135

Fax

(203) 262-6714

NPI assigned

Jul 27, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Wesley Bard

Title

Ceo Administrator

Phone

(203) 264-9135

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Skilled nursing facility certification: CCN 075371

Legal name

LUTHERAN HOME OF SOUTHBURY INC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Oct 1, 1991

Last certification

Aug 29, 2023

Beds

120

Ownership / control type

Nonprofit Corporation

Multi-facility organization

ASCENTRI CARE ALLIANCE

Organization structure

CorporationNon-profit

Incorporated

Mar 8, 1983 in CT

Enrollment address

990 Main St N
Southbury, CT 06488-1267

Nursing home name

LUTHERAN HOME OF SOUTHBURY INC

Listed as

Lutheran Home Of Southbury IncCCN 075371

Overall star rating

3 of 5

Health inspections

3 of 5

Staffing

4 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Oct 1, 1991

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

120116.2 residents per day on average

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 15

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.

• Ghulam Khan, MD

  • Family Medicine Physician
  • Pine Bluff, AR
  • NPI 1588042220

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 4

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

• Emanuel Development Corporation

  • Skilled Nursing Facility
  • Brighton, MA
  • NPI 1023588696

  Ascentria Care Alliance Inc

  CMS ownership
• Fair Havens, Inc.

  • Skilled Nursing Facility
  • West Brookfield, MA
  • NPI 1003205667

  Ascentria Care Alliance Inc

  CMS ownership
• Lutheran Home of Jamaica Plain, Inc.

  • Skilled Nursing Facility
  • Jamaica Plain, MA
  • NPI 1972039113

  Ascentria Care Alliance Inc

  CMS ownership
• Lutheran Housing Corporation - Brockton

  • Skilled Nursing Facility
  • Worcester, MA
  • NPI 1770158438

  Ascentria Care Alliance Inc

  CMS ownership

Practitioners 1

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

• Ghulam Khan, MD

  • Family Medicine Physician
  • Pine Bluff, AR
  • NPI 1588042220
  NPD (past)

Affiliated clinicians 2

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

• Alan Mervyn Radin, M.D.

  • Internal Medicine Physician
  • Wilton, CT
  • NPI 1609858414

  Nursing home

  Care Compare affiliation
• Ghulam Khan, MD

  • Family Medicine Physician
  • Pine Bluff, AR
  • NPI 1588042220

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1122422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196121600000",
    "number": "1376543751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 MAIN ST N",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064881267",
            "telephone_number": "203-264-9135",
            "fax_number": "203-262-6714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 MAIN ST N",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064881267",
            "telephone_number": "203-264-9135",
            "fax_number": "203-262-6714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN HOME OF SOUTHBURY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-27",
        "last_updated": "2007-11-27",
        "status": "A",
        "authorized_official_last_name": "BARD",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_title_or_position": "CEO ADMINISTRATOR",
        "authorized_official_telephone_number": "203-264-9135",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "699C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Southbury, CT
• Providers in Southbury, CT by specialty
• Skilled Nursing Facility in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; 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.