NPIMap

Organization Active NPI

Sullivan Operations, LLC

Doing business as Life Care Center of Sullivan

  • Skilled Nursing Facility
  • Sullivan, MO
National Provider Identifier
1568419232
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
30676 Issued in MO
Legal business name
SULLIVAN OPERATIONS, LLC
Doing business as
Life Care Center of Sullivan
Practice address
875 Dunsford Dr
Sullivan, MO 63080-1238
Phone
(573) 468-3128
Fax
(573) 860-3196
NPI assigned
May 28, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Authorized official

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

Specialties & licenses 1

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

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 names 1

  • Life Care Center of Sullivan Doing business as

Electronic endpoints 1

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

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568419232. Details of each certification follow.

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
LLCProprietary
Enrollment address
875 Dunsford Dr
Sullivan, MO 63080-1238
Nursing home name
LIFE CARE CENTER OF SULLIVAN
Affiliated entity
LIFE CARE CENTERS OF AMERICA

Care Compare: Nursing home

Medicare Care Compare
Listed as
Life Care Center of SullivanCCN 265340 · All quality measures
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
ActiveFrom the Provider of Services file
Certified beds
12073.4 residents per day on average
Chain
Life Care Centers of America194 facilities in the chain

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
26D0716476Life Care Center of Sullivan875 Dunsford Drive, Sullivan, MO 63080Certificate of waiverOct 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Cape Girardeau Operations LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

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 InterestMember Sep 6, 2002 99%
Matthew Taylor Individual W-2 Managing EmployeeAdministrator Sep 15, 2021 100%
Joan E Thurmond Individual Corporate OfficerAssistant 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%

Owners & managing parties with NPI records 25

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

View all 25

Facilities with the same owner 193

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

View all 193

Practitioners & affiliated clinicians

Practitioners 3

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": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783900800000",
    "number": "1568419232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 KEITH ST NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373123713",
            "telephone_number": "423-473-5751",
            "fax_number": "423-339-8342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 DUNSFORD DR",
            "city": "SULLIVAN",
            "state": "MO",
            "postal_code": "630801238",
            "telephone_number": "573-468-3128",
            "fax_number": "573-860-3196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A",
        "authorized_official_last_name": "CROSS",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "423-473-5867"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "30676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "284 Merchant St",
            "city": "Ste Genevieve",
            "state": "MO",
            "country_code": "US",
            "postal_code": "636701610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Life Care Center of Sullivan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sullivan, MO

Sources for this page

Verify at the official NPI Registry.