Active NPI
Waynesboro SNF Operations LLC
Doing business as Waynesboro Post Acute & Rehabilitation
- Skilled Nursing Facility
- Waynesboro, TN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- WAYNESBORO SNF OPERATIONS LLC
- Doing business as
- Waynesboro Post Acute & Rehabilitation
- Practice address
- 104 JV Mangubat Dr
Waynesboro, TN 38485-2439 - Phone
- (931) 722-3641
- NPI assigned
- Mar 29, 2024
- Last updated
- Mar 29, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Joseph Lieberman
- Title
- Vice President of Procurement
- Phone
- (646) 275-4510
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
104 JV Mangubat Dr
Waynesboro, TN 38485-2439
Mailing address
104 JV Mangubat Dr
Waynesboro, TN 38485-2439
Other names 1
- Waynesboro Post Acute & Rehabilitation
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240703003169 | TN | Part A Provider - Skilled Nursing Facility | 1759825540 | Practice locations: Waynesboro, TN |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1407607203. Details of each certification follow.
Skilled nursing facility certification: CCN 445518
- Legal name
- WAYNESBORO SNF OPERATIONS LLC
- Doing business as
- WAYNESBORO POST ACUTE & REHABILITATION
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Dec 11, 2014
- Last certification
- Jan 20, 2022
- Beds
- 109
- Ownership / control type
- Nonprofit Corporation
- Multi-facility organization
- The Trousdale Foundation Inc.
- Organization structure
- LLC
- Enrollment address
- 104 JV Mangubat Dr
Waynesboro, TN 38485-2439 - Nursing home name
- WAYNESBORO POST ACUTE & REHABILITATION
- Affiliated entity
- LYON HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Waynesboro Post Acute & Rehabilitation
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Dec 11, 2014
- Medicare certification status
- Active
- Certified beds
- 109
- Chain
- Lyon Healthcare
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 1
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 7
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 |
|---|---|---|---|
| Sabrina 1818 Holdings LLC | 5% Or Greater Indirect Ownership Interest | Jun 17, 2024 | 48.75% |
| Saessy Irrevocable Trust | 5% Or Greater Indirect Ownership Interest | Jun 17, 2024 | 46.36% |
| Miles Bergin | Operational/Managerial Control | Jun 17, 2024 | |
| Managing Control - Governing Body | Jun 17, 2024 | ||
| TN 2 SNF Operations Holdings LLC | 5% Or Greater Direct Ownership Interest | Jun 17, 2024 | 100% |
| Shimon Idels | Corporate Officer | Jun 17, 2024 | |
| Tatiriq Irrevocable Trust | 5% Or Greater Indirect Ownership Interest | Jun 17, 2024 | 46.36% |
| Lion 26 Holdings LLC | 5% Or Greater Indirect Ownership Interest | Jun 17, 2024 | 48.75% |
Facilities with the same owner 47
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba The McKendree Post Acute & Rehabilitation
- Skilled Nursing Facility
- Hermitage, TN
- NPI 1366293151
Lion 26 Holdings LLC, Sabrina 1818 Holdings LLC, Saessy Irrevocable Trust, Tatiriq Irrevocable Trust, TN 2 SNF Operations Holdings LLC
-
dba Spring Meadows Health and Rehabilitation
- Skilled Nursing Facility
- Clarksville, TN
- NPI 1245050731
Lion 26 Holdings LLC, Sabrina 1818 Holdings LLC
-
dba Alexandria Health & Rehabilitation
- Skilled Nursing Facility
- Alexandria, VA
- NPI 1346951761
Lion 26 Holdings LLC, Sabrina 1818 Holdings LLC, Saessy Irrevocable Trust, Tatiriq Irrevocable Trust
-
dba Fairmont Crossing Health and Rehab Center
- Skilled Nursing Facility
- Amherst, VA
- NPI 1174297063
Lion 26 Holdings LLC, Sabrina 1818 Holdings LLC, Saessy Irrevocable Trust, Tatiriq Irrevocable Trust
-
dba Oakwood Health and Rehab Center
- Skilled Nursing Facility
- Bedford, VA
- NPI 1508530387
Lion 26 Holdings LLC, Sabrina 1818 Holdings LLC, Saessy Irrevocable Trust, Tatiriq Irrevocable Trust
-
dba Tygart Valley Health & Rehabilitation
- Skilled Nursing Facility
- Belington, WV
- NPI 1811670607
Lion 26 Holdings LLC, Sabrina 1818 Holdings LLC, Saessy Irrevocable Trust, Tatiriq Irrevocable Trust
-
dba Shalom Gardens Health & Rehabilitation
- Skilled Nursing Facility
- Richmond, VA
- NPI 1881388510
Lion 26 Holdings LLC, Sabrina 1818 Holdings LLC, Saessy Irrevocable Trust, Tatiriq Irrevocable Trust
-
dba Blue Ridge Therapy Connection
- Skilled Nursing Facility
- Stuart, VA
- NPI 1013478411
Lion 26 Holdings LLC, Sabrina 1818 Holdings LLC, Saessy Irrevocable Trust, Tatiriq Irrevocable Trust
-
dba Carlin Springs Health & Rehabilitation
- Skilled Nursing Facility
- Arlington, VA
- NPI 1700597127
Lion 26 Holdings LLC, Sabrina 1818 Holdings LLC, Saessy Irrevocable Trust, Tatiriq Irrevocable Trust
-
dba Cortland Acres Health & Rehabilitation
- Skilled Nursing Facility
- Thomas, WV
- NPI 1396565453
Lion 26 Holdings LLC, Sabrina 1818 Holdings LLC, Saessy Irrevocable Trust, Tatiriq Irrevocable Trust
-
dba Guggenheimer Health and Rehab Center
- Skilled Nursing Facility
- Lynchburg, VA
- NPI 1679247563
Lion 26 Holdings LLC, Sabrina 1818 Holdings LLC, Saessy Irrevocable Trust, Tatiriq Irrevocable Trust
-
dba Evergreen Health and Rehabilitation Center
- Skilled Nursing Facility
- Winchester, VA
- NPI 1487221107
Lion 26 Holdings LLC, Sabrina 1818 Holdings LLC, Saessy Irrevocable Trust, Tatiriq Irrevocable Trust
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.
-
- Family Medicine Physician
- Waynesboro, TN
- NPI 1821217852
Affiliated clinicians 1
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": "1711670400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1711670400000",
"number": "1407607203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 JV MANGUBAT DR",
"city": "WAYNESBORO",
"state": "TN",
"postal_code": "384852439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 JV MANGUBAT DR",
"city": "WAYNESBORO",
"state": "TN",
"postal_code": "384852439",
"telephone_number": "931-722-3641"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WAYNESBORO SNF OPERATIONS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-03-29",
"last_updated": "2024-03-29",
"certification_date": "2024-03-29",
"status": "A",
"authorized_official_last_name": "LIEBERMAN",
"authorized_official_first_name": "JOSEPH",
"authorized_official_title_or_position": "VICE PRESIDENT OF PROCUREMENT",
"authorized_official_telephone_number": "646-275-4510"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Waynesboro Post Acute & Rehabilitation",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Waynesboro, TN
- Waynesboro Clinic, PC
- Waynesboro Emergency Services II, LLC
- Waynesboro Healthcare, LLC (Waynesboro Health and Rehabilitation Center)
- Waynesboro Healthcare, LLC (Wayne Care Nursing Home)
- Waynesboro Nursing & Rehabilitation Center LLC
- Jannakay Elizabeth Weaver, SLP-CCC
- Samuel Preston Welch, NP-C
- Wesley J. Sands Vision Center
- Jessica White
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2024; 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.