NPIMap

Organization Active NPI

Lutheran Home at Trinity Oaks, Inc.

Doing business as Lutheran Home at Trinity Oaks

  • Skilled Nursing Facility
  • Salisbury, NC
National Provider Identifier
1447254149
Registry record updated Feb 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH0197 Issued in NC
Legal business name
LUTHERAN HOME AT TRINITY OAKS, INC.
Doing business as
Lutheran Home at Trinity Oaks
Practice address
820 Klumac Rd
Salisbury, NC 28144-5728
Phone
(704) 637-3784
Fax
(704) 636-9464
NPI assigned
Jun 9, 2005
Last updated
Feb 4, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
LUTHERAN SERVICES FOR THE AGING, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 4, 2026

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

Authorized official

Name
Mr. William Johnson Jr.
Title
Administrator
Phone
(704) 637-3784

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NH0197 NC Primary

Addresses

Primary practice location

820 Klumac Rd
Salisbury, NC 28144-5728

Mailing address

820 Klumac Rd
Salisbury, NC 28144-5728
Phone (704) 637-3784

Other identifiers 2

IdentifierTypeStateIssuer
3416124MedicaidNC
3415153MedicaidNC

Other names 1

  • Lutheran Home at Trinity Oaks Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041101001112 NC Part A Provider - Skilled Nursing Facility 3274595202 Practice locations: Salisbury, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447254149. Details of each certification follow.

Skilled nursing facility certification: CCN 345153

Legal name
LUTHERAN HOME AT TRINITY OAKS, INC.
Doing business as
TRINITY OAKS
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1976
Last certification
Feb 24, 2025
Beds
127 (115 certified)
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 29, 2004 in NC
Enrollment address
820 Klumac Rd
Salisbury, NC 28144-5722
Nursing home name
TRINITY OAKS
Affiliated entity
LUTHERAN SERVICES CAROLINAS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Trinity OaksCCN 345153 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Apr 1, 1976
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
115108.2 residents per day on average
Chain
Lutheran Services Carolinas9 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Lutheran Home at Trinity Oaks Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Chetan N Amin Individual Operational/Managerial Control Oct 1, 2012
Adp of the SNF Oct 1, 2012
Kesha L Smith Individual Corporate DirectorChief Operation Officer Oct 1, 2012
Operational/Managerial Control Oct 1, 2012
Adp of the SNF Oct 1, 2012
Lutheran Home at Trinity Oaks Property Inc Organization, Salisbury, NC Corporation, Non-profit Operational/Managerial Control Jul 29, 2004
Adp of the SNF Apr 25, 2025
Richard Herman Individual Managing Control - Governing BodyBoard Vice President Jun 1, 2022
Trustee of the SNF Jun 1, 2021
Ted W Goins Individual Operational/Managerial Control Apr 30, 2007
Managing Control - Governing BodyCeo Apr 30, 2007
Trustee of the SNF Oct 1, 2004
Tim Wayne Cornelison Individual Operational/Managerial Control Jun 2, 2022
Adp of the SNF Jun 2, 2022
Douglas E Nelson Individual Managing Control - Governing BodyBoard Chair Sep 1, 2022
Trustee of the SNF Sep 1, 2022
Karen Maddry Individual Corporate OfficerSecretary Apr 1, 1982
Managing Control - Governing BodySecreatry Oct 1, 2004
Lutheran Services for the Aging, Inc. Organization, Salisbury, NC Corporation, Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 2004 100%
Trustee of the SNF Jul 29, 2004
Kirby Nickerson Individual Corporate OfficerCfo Oct 1, 2012
Operational/Managerial Control Oct 1, 2012
Adp of the SNF Oct 1, 2012
Lsa Management, Inc. Organization, Salisbury, NC Non-profit Operational/Managerial Control Jul 29, 2004
Adp of the SNF Apr 14, 2025

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 5

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": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770163200000",
    "number": "1447254149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 KLUMAC RD",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281445728",
            "telephone_number": "704-637-3784",
            "fax_number": "704-636-9464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 KLUMAC RD",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281445728",
            "telephone_number": "704-637-3784",
            "fax_number": "704-636-9464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN HOME AT TRINITY OAKS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LUTHERAN SERVICES FOR THE AGING, INC.",
        "enumeration_date": "2005-06-09",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "704-637-3784",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3416124",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3415153",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lutheran Home at Trinity Oaks",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salisbury, NC

Sources for this page

Verify at the official NPI Registry.