NPIMap

Organization Active NPI

Greenville Nursing and Rehabilitation LLC

  • Skilled Nursing Facility
  • Greenville, KY
National Provider Identifier
1407401375
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
GREENVILLE NURSING AND REHABILITATION LLC
Practice address
521 Greene Dr
Greenville, KY 42345-1409
Phone
(270) 377-0070
NPI assigned
Aug 7, 2019
Last updated
Jul 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

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

Authorized official

Name
Paul Pruitt
Title
Officer
Phone
(317) 288-4029

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

521 Greene Dr
Greenville, KY 42345-1409

Mailing address

100 Boulevard of Americas
Lakewood, NJ 08701-4585
Phone (732) 961-8400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191003002796 KY Part A Provider - Skilled Nursing Facility 8628309754 Practice locations: Greenville, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407401375. Details of each certification follow.

Skilled nursing facility certification: CCN 185317

Legal name
GREENVILLE NURSING AND REHABILITATION LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 1, 1992
Last certification
Jun 20, 2024
Beds
60
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Jul 25, 2019 in IN
Enrollment address
521 Greene Dr
Greenville, KY 42345-1409
Nursing home name
GREENVILLE NURSING AND REHABILITATION
Affiliated entity
DAVID MARX

Care Compare: Nursing home

Medicare Care Compare
Listed as
Greenville Nursing and RehabilitationCCN 185317 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Feb 1, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6056.8 residents per day on average
Chain
David Marx10 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D0326451Greenville Nursing and Rehabilitation, LLC521 Greene Drive, Greenville, KY 42345Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
David Alexander Individual Operational/Managerial Control May 1, 2023
Adp of the SNF May 1, 2023
Individual Adp of the SNF Jan 1, 2025
521 Greene Dr SNF Realty Holdings LLC Organization, Fresh Meadows, NY LLC, Holding company Adp of the SNF Sep 1, 2019
Kentucky SNF Realty Holdings LLC Organization, Fresh Meadows, NY LLC, Holding company Adp of the SNF Sep 1, 2019
Angela Rewa Individual Operational/Managerial Control Oct 23, 2023
Adp of the SNF Oct 23, 2023
Robert Laron Russell Individual Operational/Managerial Control Apr 8, 2024
Adp of the SNF Apr 8, 2024
Paul Pruitt Individual Operational/Managerial Control May 1, 2023
Managing Control - Governing BodyCeo May 1, 2023
Adp of the SNF Sep 1, 2019
MDG Real Estate Global Limited Organization, Fresh Meadows, NY Corporation Adp of the SNF Sep 1, 2019
Organization, Lakewood, NJ LLC Adp of the SNF Jul 16, 2025
Bluegrass Consulting Group LLC Organization, Westfield, IN LLC, Management services company Operational/Managerial Control Sep 1, 2019
Adp of the SNF Jul 16, 2025
Margaret Chamberlain Individual Operational/Managerial Control Sep 11, 2023
Adp of the SNF Sep 11, 2023
Shannon Landrum Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Anzhelika Shatrov Individual Operational/Managerial Control Dec 2, 2024
Adp of the SNF Dec 2, 2024
David Marx Individual 5% Or Greater Indirect Ownership Interest Jul 25, 2019 100%
Operational/Managerial Control Sep 1, 2019
Adp of the SNF Sep 1, 2019
Greenville Nursing and Rehabilitation Holdings LLC Organization, Greenville, KY Created for acquisition, LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jul 25, 2019 100%
521 Greene Dr SNF Realty LLC Organization, Fresh Meadows, NY LLC Operational/Managerial Control Sep 1, 2019
Adp of the SNF Sep 1, 2019
Eric Wolfe Individual Operational/Managerial Control Sep 11, 2023
Adp of the SNF Sep 11, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 8

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

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 2

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": "1565136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1407401375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BOULEVARD OF AMERICAS",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087014585",
            "telephone_number": "732-961-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 GREENE DR",
            "city": "GREENVILLE",
            "state": "KY",
            "postal_code": "423451409",
            "telephone_number": "270-377-0070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE NURSING AND REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-07",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A",
        "authorized_official_last_name": "PRUITT",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "317-288-4029"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, KY

Sources for this page

Verify at the official NPI Registry.