NPIMap

Organization Active NPI

Caruthersville No 1 Inc

Doing business as Southgate Living Center

  • Skilled Nursing Facility
  • Caruthersville, MO
National Provider Identifier
1457708018
Registry record updated Dec 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
045843 Issued in MO
Legal business name
CARUTHERSVILLE NO 1 INC
Doing business as
Southgate Living Center
Practice address
500 Truman Blvd
Caruthersville, MO 63830-1261
Phone
(573) 333-5150
NPI assigned
May 24, 2016
Last updated
Dec 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2017

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

Authorized official

Name
Donald B Bedell
Title
President
Phone
(573) 471-1276

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 045843 MO Primary

Addresses

Primary practice location

500 Truman Blvd
Caruthersville, MO 63830-1261

Mailing address

731 N Main St
P. O. Box 1210
Sikeston, MO 63801-2151
Phone (573) 471-1276

Other names 1

  • Southgate Living Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161108001523 MO Part A Provider - Skilled Nursing Facility 8022397488 Practice locations: Caruthersville, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457708018. Details of each certification follow.

Skilled nursing facility certification: CCN 265771

Legal name
CARUTHERSVILLE NO 1 INC
Doing business as
SOUTHGATE LIVING CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 18, 2003
Last certification
Mar 6, 2025
Beds
94
Ownership / control type
Individual
Most recent change of ownership
Aug 1, 2016
Organization structure
CorporationProprietary
Enrollment address
500 Truman Blvd
Caruthersville, MO 63830-1261
Nursing home name
SOUTHGATE LIVING CENTER
Affiliated entity
CIRCLE B ENTERPRISES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Southgate Living CenterCCN 265771 · All quality measures
Overall star rating
4 of 5
Health inspections
5 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Dec 18, 2003
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9465.7 residents per day on average
Chain
Circle B Enterprises36 facilities in the chain
Penalties (3 years)
1Fines totaling $13,397

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
26D2118071Southgate Living Center500 Truman, Caruthersville, MO 63830Certificate of waiverAug 29, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
The Caruthersville Exempt Trust Organization, Sikeston, MO 5% Or Greater Direct Ownership Interest May 4, 2016 100%
Trustee of the SNF May 4, 2016
Caruthersville Re LLC Organization, Sikeston, MO LLC Adp of the SNF May 4, 2016
Crystal Fine Individual Operational/Managerial Control Mar 1, 2024
Adp of the SNF Mar 1, 2024
Sovereign Healthcare Group LLC Organization, Sikeston, MO LLC, Medical provider/supplier Operational/Managerial Control Apr 23, 2021
Adp of the SNF Apr 6, 2025
FG LLC Organization, Sikeston, MO LLC Adp of the SNF Dec 2, 2016
Mid States Inc Organization, Sikeston, MO Corporation, Management services company Adp of the SNF Aug 1, 2016
Van de Ven LLC Organization, Cape Girardeau, MO LLC Adp of the SNF Aug 1, 2016
Todd Beaird Individual Corporate OfficerCorporate Secretary Jan 1, 2022
Adp of the SNF Jan 1, 2022
Donald B Bedell Individual Corporate OfficerPresident May 4, 2016 100%
Corporate DirectorPresident May 4, 2016 100%
Operational/Managerial Control May 4, 2016
Individual Adp of the SNF Jan 1, 2000
Abdullah Arshad Individual Operational/Managerial Control Aug 1, 2016
Adp of the SNF Aug 1, 2016
DCB Real Estate Partnership LP Organization, Sikeston, MO Adp of the SNF May 4, 2016
Individual Adp of the SNF Jan 1, 2000
Forvis Mazars LLP Organization, Springfield, MO Consulting firm Adp of the SNF Aug 16, 2021
Agh1 LLC Organization, Sikeston, MO LLC, Management services company, Consulting firm Operational/Managerial Control Dec 2, 2016
Adp of the SNF Jun 4, 2025

Owners & managing parties with NPI records 2

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

Facilities with the same owner 36

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

View all 36

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": "1464048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512950400000",
    "number": "1457708018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 N MAIN ST",
            "address_2": "P. O. BOX 1210",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638012151",
            "telephone_number": "573-471-1276",
            "fax_number": "573-472-8504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 TRUMAN BLVD",
            "city": "CARUTHERSVILLE",
            "state": "MO",
            "postal_code": "638301261",
            "telephone_number": "573-333-5150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARUTHERSVILLE NO 1 INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-24",
        "last_updated": "2017-12-11",
        "status": "A",
        "authorized_official_last_name": "BEDELL",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-471-1276"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "045843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southgate Living Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Caruthersville, MO

Sources for this page

Verify at the official NPI Registry.