LP Byrdstown LLC
Organization Active NPI Nursing Facility/Intermediate Care Facility · Byrdstown, TN
NPI 1407047798 · NPPES record last updated Apr 4, 2023
Key facts
- NPI
- 1407047798
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nursing Facility/Intermediate Care Facility 313M00000X
- License
- 202 (TN)
- Legal business name
- LP BYRDSTOWN LLC
- Practice address
- 129 Hillcrest Dr
Byrdstown, TN 38549-2326 - Phone
- (931) 864-3162
- Fax
- (931) 864-6260
- NPI assigned
- Aug 5, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- LP CR HOLDINGS LLC
Authorized official
- Name
- Mr. John Harrison
- Title
- Cfo
- Phone
- (502) 568-7800
Facilities with the same owner 64
Practitioners 2
Affiliated clinicians 3
Medicare Care Compare: Nursing home
- Listed as
- Pickett Care and Rehabilitation Center
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Apr 1, 1997
- Medicare certification status
- Active
- Certified beds
- 69 · 56.0 residents per day on average
- Chain
- Signature Healthcare
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0316163 | LP Byrdstown LLC | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Skilled nursing facility certification: CCN 445390
- Legal name
- LP BYRDSTOWN LLC
- Doing business as
- PICKETT CARE AND REHABILITATION CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Apr 1, 1997
- Last certification
- Apr 9, 2025
- Beds
- 69
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Signature Healthcare
- Most recent change of ownership
- Nov 1, 2007
- Organization structure
- LLC · Proprietary
- Incorporated
- Nov 8, 2006 in DE
- Enrollment address
- 129 Hillcrest Dr
Byrdstown, TN 38549-2326 - Nursing home name
- PICKETT CARE AND REHABILITATION CENTER
- Affiliated entity
- SIGNATURE HEALTHCARE
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Ira Smedra |
5% Or Greater Indirect Ownership Interest | Nov 1, 2007 | 12% |
| Agemo Holdings LLC |
5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 100% |
| Noah Foster |
W-2 Managing Employee |
May 23, 2023 | |
| Lpsnf II LLC |
5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 74% |
| Signature Healthcare LLC |
Operational/Managerial Control | Nov 1, 2007 | |
| John H Harrison |
Corporate Officer |
Nov 1, 2007 | |
| Wheaten LLC |
5% Or Greater Indirect Ownership Interest | Nov 1, 2007 | 5% |
| Elmer Joseph Steier III |
5% Or Greater Indirect Ownership Interest | Nov 1, 2007 | 20% |
| LP CR Holdings LLC |
5% Or Greater Direct Ownership Interest | Nov 1, 2007 | 100% |
| Jjla LLC |
5% Or Greater Indirect Ownership Interest | Nov 1, 2007 | 20% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071008000104 | TN | Part a Provider - Skilled Nursing Facility | 7719072677 | Practice locations: Byrdstown, TN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | 202 | TN | Yes |
| Skilled Nursing Facility | 314000000X | 202 | TN |
Addresses
Primary practice location
129 Hillcrest Dr
Byrdstown, TN 38549-2326
Mailing address
12201 Bluegrass Parkway
Louisville, KY 40299-2361
Phone (502) 568-7800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7440468 | Medicaid | TN | |
| 0445390 | Medicaid | TN |
Other names
- Pickett Care & Rehabilitation Center
Other providers in Byrdstown, TN
- HQM of Byrdstown, LLC
- Impact Health LLC
- Sarah Ames Koger
- Katherine Rosser Langenberg
- Karen Logan
- Larry Michael Mason
- Pickett County Goverment
- Laura B. Reagan
- Tim Wayne Reagan
- Victoria Grace Reagan
All providers in Byrdstown, TN · Nursing Facility/Intermediate Care 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 Apr 4, 2023. 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.