NPIMap

Sullivan Operations, LLC

Organization Active NPI Skilled Nursing Facility · Sullivan, MO

NPI 1568419232 · NPPES record last updated Jul 13, 2026

Key facts

NPI
1568419232
Entity type
Organization (NPI type 2)
Primary specialty
Skilled Nursing Facility 314000000X
License
30676 (MO)
Legal business name
SULLIVAN OPERATIONS, LLC
Practice address
875 Dunsford Dr
Sullivan, MO 63080-1238
Phone
(573) 468-3128
Fax
(573) 860-3196
NPI assigned
May 28, 2006
Organization subpart
No

Authorized official

Name
Cindy S Cross
Title
Assistant Secretary
Phone
(423) 473-5867

Owners & managing parties with NPI records 25

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

Corporate family (same tax ID) 1

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

Facilities with the same owner 193

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

View all 193

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

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

Medicare Care Compare: Nursing home

Listed as
Life Care Center of Sullivan CCN 265340
Overall star rating
★★★★☆ 4 of 5
Health inspections
★★★★☆ 4 of 5
Staffing
★★☆☆☆ 2 of 5
Quality measures
★★★☆☆ 3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jan 1, 1989
Medicare certification status
Active (Provider of Services file)
Certified beds
120 · 73.4 residents per day on average
Chain
Life Care Centers of America (194 facilities)

Source: Medicare Care Compare, processed Aug 1, 2026.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0716476Life Care Center of Sullivan
875 Dunsford Drive, Sullivan, MO 63080		Certificate of waiverOct 31, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MO

Skilled nursing facility certification: CCN 265340

Legal name
SULLIVAN OPERATIONS, LLC
Doing business as
LIFE CARE CENTER OF SULLIVAN
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1989
Last certification
Oct 4, 2024
Beds
120
Ownership / control type
Corporation
Multi-facility organization
LIFE CARE CENTERS OF AMERICA
Most recent change of ownership
Dec 1, 2002
Organization structure
LLC · Proprietary
Enrollment address
875 Dunsford Dr
Sullivan, MO 63080-1238
Nursing home name
LIFE CARE CENTER OF SULLIVAN
Affiliated entity
LIFE CARE CENTERS OF AMERICA

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Forrest L Preston
Individual 		5% Or Greater Direct Ownership Interest
Member		 Sep 6, 2002 99%
Matthew Taylor
Individual 		W-2 Managing Employee
Administrator		 Sep 15, 2021 100%
Joan E Thurmond
Individual 		Corporate Officer
Assistant Secretary		 Sep 6, 2002
Cindy S Cross
Individual 		Corporate Officer Sep 6, 2002
Life Care Centers of America, Inc.
Organization · Cleveland, TN
Corporation, Management services company, For-profit 		Operational/Managerial Control Sep 25, 2002 100%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20021202000005 MO Part a Provider - Skilled Nursing Facility 2365350600 Practice locations: Sullivan, MO

National Provider Directory

Tax ID family
Cape Girardeau Operations LLC (2 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 30676 MO Yes

Addresses

Primary practice location

875 Dunsford Dr
Sullivan, MO 63080-1238

Mailing address

3001 Keith St NW
Cleveland, TN 37312-3713
Phone (423) 473-5751

Other identifiers

IdentifierTypeStateIssuer
101763001MedicaidMO

Other names

  • Life Care Center of Sullivan Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Other providers in Sullivan, MO

All providers in Sullivan, MO · Skilled Nursing Facility in Missouri

Sources for this page

Verify at the official NPI Registry.