Crockett County Nursing Home, Inc.

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

0000000029 Issued in TN

Legal business name

CROCKETT COUNTY NURSING HOME, INC.

Practice address

580 West Main Street
Alamo, TN 38001-0367

Phone

(731) 696-4541

Fax

(731) 696-4948

NPI assigned

Jan 16, 2007

Last updated

Jun 23, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Barbara Park

Title

Administrator

Phone

(731) 696-4541

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497807119. Details of each certification follow.

• CCN 445467 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 445467

Legal name

CROCKETT COUNTY NURSING HOME, INC.

Doing business as

ALAMO NURSING AND REHABILITATION CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Oct 15, 2002

Last certification

Feb 12, 2025

Beds

121

Ownership / control type

Corporation

Multi-facility organization

Harber Laman Healthcare Management

Organization structure

CorporationProprietary

Incorporated

Mar 18, 1980 in TN

Enrollment address

580 W Main St
Alamo, TN 38001-1545

Nursing home name

ALAMO NURSING AND REHABILITATION CENTER

Listed as

Alamo Nursing and Rehabilitation CenterCCN 445467 · 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

Oct 15, 2002

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

12154.5 residents per day on average

Penalties (3 years)

2Fines totaling $12,542

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 3

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

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.

• Loren Carroll, MD

  • Family Medicine Physician
  • Jackson, TN
  • NPI 1104168178
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Loren Carroll, MD

  • Family Medicine Physician
  • Jackson, TN
  • NPI 1104168178

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592870400000",
    "number": "1497807119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 367",
            "city": "ALAMO",
            "state": "TN",
            "postal_code": "380010367",
            "telephone_number": "731-696-4541",
            "fax_number": "731-696-4948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 WEST MAIN STREET",
            "city": "ALAMO",
            "state": "TN",
            "postal_code": "380010367",
            "telephone_number": "731-696-4541",
            "fax_number": "731-696-4948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROCKETT COUNTY NURSING HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "731-696-4541",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "TN",
            "license": "0000000029",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7440325",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID LEVEL II",
            "identifier": "0445467",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cavalier Pharmacy LLC (Cavalier Pharmacy)
• Megan Chapman, FNP
• City of Alamo Superintendent of Schools
• Donna Paige Clement, APN
• County of Crockett (Crockett County Ambulance Service)
• Crockett County Office on Aging, Inc.
• Crockett Medical Clinic Inc
• Crockett Spine & Sport PLLC
• Derrick Smith Counseling LLC
• Paula Eubanks

• Nursing Facility/Intermediate Care Facility in Alamo, TN
• Providers in Alamo, TN by specialty
• Nursing Facility/Intermediate Care Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; 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.

Verify at the official NPI Registry.