Active NPI
LP Byrdstown LLC
Doing business as Pickett Care & Rehabilitation Center
- Nursing Facility/Intermediate Care Facility
- Byrdstown, TN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Facility/Intermediate Care Facility
- License
- 202
- Legal business name
- LP BYRDSTOWN LLC
- Doing business as
- Pickett Care & Rehabilitation Center
- Practice address
- 129 Hillcrest Dr
Byrdstown, TN 38549-2326 - Phone
- (931) 864-3162
- Fax
- (931) 864-6260
- NPI assigned
- Aug 5, 2007
- Last updated
- Apr 4, 2023
- Organization subpart
- Yes
- Parent organization
- LP CR HOLDINGS LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. John Harrison
- Title
- Cfo
- Phone
- (502) 568-7800
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | 202 | TN | Primary |
| 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 names 1
- Pickett Care & Rehabilitation Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071008000104 | TN | Part A Provider - Skilled Nursing Facility | 7719072677 | Practice locations: Byrdstown, TN |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1407047798. Details of each certification follow.
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
- 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
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Pickett Care and Rehabilitation Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Apr 1, 1997
- Medicare certification status
- Active
- Certified beds
- 69
- Chain
- Signature Healthcare
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0316163 | LP Byrdstown LLC | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryLocations
129 Hillcrest Dr
Byrdstown, TN 38549
Phone (931) 864-3162
Ownership & related parties
All disclosed owners & managing parties 10
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| 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% |
Facilities with the same owner 64
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Signature HealthCARE of Clarksville
- Nursing Facility/Intermediate Care Facility
- Clarksville, TN
- NPI 1891985131
Jjla LLC, Wheaten LLC
-
dba Signature HealthCARE of Cleveland
- Nursing Facility/Intermediate Care Facility
- Cleveland, TN
- NPI 1508057456
Agemo Holdings LLC, Jjla LLC, LP CR Holdings LLC, Lpsnf II LLC, Wheaten LLC
-
dba Signature HealthCARE of Putnam County
- Skilled Nursing Facility
- Cookeville, TN
- NPI 1144645870
Jjla LLC, Wheaten LLC
-
dba Signature HealthCARE of Elizabethton Rehab & Wellness Center
- Nursing Facility/Intermediate Care Facility
- Elizabethton, TN
- NPI 1255521555
Agemo Holdings LLC, Jjla LLC, LP CR Holdings LLC, Lpsnf II LLC, Signature Healthcare LLC, Wheaten LLC
-
dba Signature HealthCARE of Erin
- Nursing Facility/Intermediate Care Facility
- Erin, TN
- NPI 1457541872
Agemo Holdings LLC, Jjla LLC, LP CR Holdings LLC, Lpsnf II LLC, Signature Healthcare LLC, Wheaten LLC
-
dba Signature HealthCARE of Greeneville
- Nursing Facility/Intermediate Care Facility
- Greeneville, TN
- NPI 1699966986
Agemo Holdings LLC, Jjla LLC, LP CR Holdings LLC, Lpsnf II LLC, Wheaten LLC
-
dba Signature HealthCARE of Fentress County
- Nursing Facility/Intermediate Care Facility
- Jamestown, TN
- NPI 1174713598
Agemo Holdings LLC, Jjla LLC, LP CR Holdings LLC, Lpsnf II LLC, Wheaten LLC
-
dba Princeton Transitional Care & Assisted Living
- Skilled Nursing Facility
- Johnson City, TN
- NPI 1043798424
Jjla LLC, Wheaten LLC
-
dba Signature HealthCARE of Memphis
- Nursing Facility/Intermediate Care Facility
- Memphis, TN
- NPI 1831380120
Agemo Holdings LLC, Jjla LLC, LP CR Holdings LLC, Lpsnf II LLC, Wheaten LLC
-
dba Signature HealthCARE of Primacy
- Skilled Nursing Facility
- Memphis, TN
- NPI 1760898415
Jjla LLC, Wheaten LLC
-
dba Signature HealthCARE of Monteagle Rehab & Wellness Center
- Nursing Facility/Intermediate Care Facility
- Monteagle, TN
- NPI 1528259561
Agemo Holdings LLC, Jjla LLC, LP CR Holdings LLC, Lpsnf II LLC, Wheaten LLC
-
dba Standing Stone Care & Rehabilitation Center
- Nursing Facility/Intermediate Care Facility
- Monterey, TN
- NPI 1922299213
Agemo Holdings LLC, Jjla LLC, LP CR Holdings LLC, Lpsnf II LLC, Wheaten LLC
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Family Medicine Physician
- Harriman, TN
- NPI 1073568218
-
- Family Medicine Physician
- Albany, KY
- NPI 1922251123
Affiliated clinicians 3
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186272000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1680566400000",
"number": "1407047798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12201 BLUEGRASS PARKWAY",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402992361",
"telephone_number": "502-568-7800",
"fax_number": "502-568-7150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "129 HILLCREST DR",
"city": "BYRDSTOWN",
"state": "TN",
"postal_code": "385492326",
"telephone_number": "931-864-3162",
"fax_number": "931-864-6260"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LP BYRDSTOWN LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "LP CR HOLDINGS LLC",
"enumeration_date": "2007-08-05",
"last_updated": "2023-04-04",
"certification_date": "2023-04-04",
"status": "A",
"authorized_official_last_name": "HARRISON",
"authorized_official_first_name": "JOHN",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "502-568-7800",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "313M00000X",
"taxonomy_group": "",
"desc": "Nursing Facility/Intermediate Care Facility",
"state": "TN",
"license": "202",
"primary": true
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "TN",
"license": "202",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Pickett Care & Rehabilitation Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Pickett Care & Rehabilitation Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Byrdstown, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2023; 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.