Cherryvale Management, LLC
Organization Active NPI Skilled Nursing Facility · Cherryvale, KS
NPI 1396794558 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1396794558
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- N063002 (KS)
- Legal business name
- CHERRYVALE MANAGEMENT, LLC
- Practice address
- 1001 W Main St
Cherryvale, KS 67335-1104 - Phone
- (620) 336-2102
- Fax
- (620) 336-2236
- NPI assigned
- May 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Stephanie J Bean
- Title
- Administrator
- Phone
- (620) 336-2102
Owners & managing parties with NPI records 1
-
Skylar P Stacy, MD
Facilities with the same owner 4
Practitioners 2
-
Tonya Lynn Hill, M.D.
-
Skylar P Stacy, MD
Affiliated clinicians 3
-
Tonya Lynn Hill, M.D.
-
Marc A Hoffmeister, PA-C
-
Skylar P Stacy, MD
Medicare Care Compare: Nursing home
- Listed as
- Advena Living of Cherryvale
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★☆☆☆☆ 1 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Dec 15, 1994
- Medicare certification status
- Active
- Certified beds
- 45 · 33.5 residents per day on average
- Chain
- Advena Living Communities
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D0718520 | Advena Living of Cherryvale | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Skilled nursing facility certification: CCN 175335
- Legal name
- CHERRYVALE MANAGEMENT, LLC
- Doing business as
- ADVENA LIVING OF CHERRYVALE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Dec 15, 1994
- Last certification
- Jan 4, 2024
- Beds
- 45
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Advena Living
- Organization structure
- LLC · Proprietary
- Enrollment address
- 1001 W Main St
Cherryvale, KS 67335-1104 - Nursing home name
- ADVENA LIVING OF CHERRYVALE
- Affiliated entity
- ADVENA LIVING COMMUNITIES
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| |
Adp of the SNF | May 11, 2025 | |
| William M Novotny |
Corporate Officer |
Sep 1, 2018 | 75% |
| Corporate Director |
Sep 1, 2018 | 75% | |
| Operational/Managerial Control |
Sep 1, 2018 | 100% | |
| Indirect Ownership Interest | Sep 1, 2018 | 75% | |
| New Paradigm Solutions Inc |
Operational/Managerial Control | Sep 1, 2018 | 100% |
| Adp of the SNF | May 12, 2025 | ||
| Michelle D Novotny |
Corporate Officer |
Sep 1, 2018 | 25% |
| Operational/Managerial Control | Sep 1, 2018 | ||
| Indirect Ownership Interest | Sep 1, 2018 | 25% | |
| Cghii Inc |
Direct Ownership Interest | Sep 1, 2018 | 75% |
| Skylar P Stacy |
Operational/Managerial Control | Jan 14, 2025 | |
| Adp of the SNF | Jan 14, 2025 | ||
| Melissa Preston |
Operational/Managerial Control | Aug 31, 2022 | |
| Adp of the SNF | Aug 31, 2022 | ||
| Cornerstone Employment Solutions Inc |
Adp of the SNF | Sep 1, 2018 | |
| Cornerstone Group Holdings Inc |
Indirect Ownership Interest | Sep 1, 2018 | 100% |
| Berniece F Patterson |
Direct Ownership Interest | Jul 1, 2024 | 25% |
| |
Adp of the SNF | May 11, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070124000462 | KS | Part a Provider - Skilled Nursing Facility | 0547261182 | Practice locations: Cherryvale, KS |
National Provider Directory
Locations
1001 W Main St
Cherryvale, KS 67335
Phone (405) 249-2357
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | N063002 | KS | Yes |
Addresses
Primary practice location
1001 W Main St
Cherryvale, KS 67335-1104
Mailing address
1001 W Main St
P O Box 366
Cherryvale, KS 67335-1104
Phone (620) 336-2102
Other names
- CHERRYVALE NURSING & REHABILITATION CENTER
Other providers in Cherryvale, KS
- Trevor Austin
- Cherryvale Care Center
- City of Cherryvale
- Angela Dick
- Belle Dickens
- Christopher Ray Douthit
- Elesha B Draeger
All providers in Cherryvale, KS · Skilled Nursing Facility in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. 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.