NPIMap

Organization Active NPI

Black Wolf Healthcare LLC

  • Skilled Nursing Facility
  • Decaturville, TN
National Provider Identifier
1447085782
Registry record updated Nov 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
BLACK WOLF HEALTHCARE LLC
Practice address
524 W Main St
Decaturville, TN 38329-8101
Phone
(731) 852-3591
NPI assigned
Sep 5, 2024
Last updated
Nov 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2025

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

Authorized official

Name
Soon Burnam
Title
Treasurer
Phone
(949) 540-1249

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X NU
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

524 W Main St
Decaturville, TN 38329-8101

Mailing address

524 W Main St
Decaturville, TN 38329-8101

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250604002614 TN Part A Provider - Skilled Nursing Facility 0244749844 Practice locations: Decaturville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447085782. Details of each certification follow.

Skilled nursing facility certification: CCN 445449

Legal name
BLACK WOLF HEALTHCARE LLC
Doing business as
WESTWOOD NURSING AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 2002
Last certification
May 14, 2025
Beds
90
Ownership / control type
Corporation
Most recent change of ownership
Jan 1, 2025
Organization structure
LLCProprietary
Enrollment address
524 W Main St
Decaturville, TN 38329-8101
Nursing home name
WESTWOOD NURSING AND REHABILITATION
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Westwood Nursing and RehabilitationCCN 445449 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Apr 1, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9044.6 residents per day on average
Chain
The Ensign Group342 facilities in the chain
Penalties (3 years)
1Fines totaling $9,620

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
44D0858927Black Wolf Healthcare, LLC524 West Main Street, Decaturville, TN 38329Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Loren S Carroll Individual Adp of the SNF Jan 1, 2025
Tyler Albrechtsen Individual Corporate OfficerRocky Top Pres, Black Wolf Manager Aug 13, 2024
Melinda Wade Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Feb 20, 2025
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Aug 13, 2024 100%
Ami Sato Individual Corporate OfficerTreasurer of Black Wolf Healthcare Sep 9, 2024
Brent Thatcher Individual Corporate OfficerPresident of Black Wolf Healthcare Aug 13, 2024
Rocky Top Healthcare LLC Organization, San Juan Capistrano, CA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 13, 2024 100%
Soon Burnam Individual Corporate OfficerSecretary of Black Wolf Healthcare Aug 13, 2024

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 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": "1725494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763078400000",
    "number": "1447085782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 W MAIN ST",
            "city": "DECATURVILLE",
            "state": "TN",
            "postal_code": "383298101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 W MAIN ST",
            "city": "DECATURVILLE",
            "state": "TN",
            "postal_code": "383298101",
            "telephone_number": "731-852-3591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK WOLF HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-05",
        "last_updated": "2025-11-14",
        "certification_date": "2025-11-14",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decaturville, TN

Sources for this page

Verify at the official NPI Registry.