Nicholasville Nursing and Rehabilitation LLC
Organization Active NPI Skilled Nursing Facility · Nicholasville, KY
NPI 1407401417 · NPPES record last updated Jul 20, 2023
Key facts
- NPI
- 1407401417
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- NICHOLASVILLE NURSING AND REHABILITATION LLC
- Practice address
- 100 Sparks Ave
Nicholasville, KY 40356-1004 - Phone
- (859) 885-4171
- NPI assigned
- Aug 6, 2019
- Organization subpart
- No
Authorized official
- Name
- Paul Pruitt
- Title
- Officer
- Phone
- (317) 288-4029
Owners & managing parties with NPI records 2
-
Laura Faughn, M.D.
Facilities with the same owner 8
Practitioners 3
-
Ralph A. Alvarado, M.D.
-
Muhammad Babar, M.D.
-
Laura Faughn, M.D.
Affiliated clinicians 3
-
Ralph A. Alvarado, M.D.
-
Laura Faughn, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Nicholasville Nursing and Rehabilitation
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Nov 16, 1990
- Medicare certification status
- Active
- Certified beds
- 73 · 68.8 residents per day on average
- Chain
- David Marx
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D0322524 | Nicholasville Nursing and Rehabilitation, LLC | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Skilled nursing facility certification: CCN 185220
- Legal name
- NICHOLASVILLE NURSING AND REHABILITATION LLC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 16, 1990
- Last certification
- Sep 12, 2024
- Beds
- 73
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Bluegrass Consulting Group
- Organization structure
- LLC · Proprietary
- Incorporated
- Jul 25, 2019 in IN
- Enrollment address
- 100 Sparks Ave
Nicholasville, KY 40356-1004 - Nursing home name
- NICHOLASVILLE NURSING AND REHABILITATION
- Affiliated entity
- DAVID MARX
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| David Alexander |
Operational/Managerial Control | May 1, 2023 | |
| Adp of the SNF | May 1, 2023 | ||
| Lisa S Davis |
Operational/Managerial Control | Jan 1, 2025 | |
| Adp of the SNF | Jan 1, 2025 | ||
| Kentucky SNF Realty Holdings LLC |
Adp of the SNF | Sep 1, 2019 | |
| Laura L Faughn |
Operational/Managerial Control | Jan 1, 2025 | |
| Adp of the SNF | Jan 1, 2025 | ||
| Angela Rewa |
Operational/Managerial Control | Oct 23, 2023 | |
| Adp of the SNF | Oct 23, 2023 | ||
| Robert Laron Russell |
Operational/Managerial Control | Apr 8, 2024 | |
| Adp of the SNF | Apr 8, 2024 | ||
| Paul Pruitt |
Operational/Managerial Control | May 1, 2023 | |
| Managing Control - Governing Body |
May 1, 2023 | ||
| Adp of the SNF | May 1, 2023 | ||
| MDG Real Estate Global Limited |
Adp of the SNF | Sep 1, 2019 | |
| 100 Sparks Ave SNF Realty LLC |
Operational/Managerial Control | Sep 1, 2019 | |
| Adp of the SNF | Sep 1, 2019 | ||
| Bluegrass Consulting Group LLC |
Operational/Managerial Control | Sep 1, 2019 | |
| Adp of the SNF | Jul 16, 2025 | ||
| |
Adp of the SNF | Jul 16, 2025 | |
| Margaret Chamberlain |
Operational/Managerial Control | Sep 11, 2023 | |
| Adp of the SNF | Sep 11, 2023 | ||
| Nicholasville Nursing and Rehabilitation Holdings LLC |
5% Or Greater Direct Ownership Interest | Jul 25, 2019 | 100% |
| Anzhelika Shatrov |
Operational/Managerial Control | Dec 2, 2024 | |
| Adp of the SNF | Dec 2, 2024 | ||
| David Marx |
5% Or Greater Indirect Ownership Interest | Jul 25, 2019 | 100% |
| Operational/Managerial Control | Sep 1, 2019 | ||
| Adp of the SNF | Sep 1, 2019 | ||
| 100 Sparks Ave Realty Holdings LLC |
Adp of the SNF | Sep 1, 2019 | |
| Eric Wolfe |
Operational/Managerial Control | Sep 11, 2023 | |
| Adp of the SNF | Sep 11, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191004001034 | KY | Part a Provider - Skilled Nursing Facility | 2961733043 | Practice locations: Nicholasville, KY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
100 Sparks Ave
Nicholasville, KY 40356-1004
Mailing address
100 Boulevard of Americas
Lakewood, NJ 08701-4585
Phone (732) 961-8400
Other providers in Nicholasville, KY
- New Vista of the Bluegrass Inc
- Ashley Newman
- Teresa Newsome
- Nicholasville Family Chiropractic
- Nicholasville Family Chiropractic, LLC
- Nicholasville Pharmacist Group
- Nicholasville Pharmacist Group
- Nicholasville Pharmacy Services Inc
- Nicholasville Pharmacy Services Inc
- Nicholasville Pharmacy Services Inc
All providers in Nicholasville, KY · Skilled Nursing Facility in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 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.