NPIMap

Organization Active NPI

Fannin County Hospital Authority

Doing business as Cedar Lake Wellness & Rehabilitation

  • Skilled Nursing Facility
  • Malakoff, TX
National Provider Identifier
1639945280
Registry record updated Aug 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
FANNIN COUNTY HOSPITAL AUTHORITY
Doing business as
Cedar Lake Wellness & Rehabilitation
Practice address
1611 W Royall Blvd
Malakoff, TX 75148-6202
Phone
(903) 489-1702
NPI assigned
Nov 27, 2023
Last updated
Aug 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2026

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

Authorized official

Name
Denver Sheddy
Title
Manager
Phone
(903) 583-1854

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1611 W Royall Blvd
Malakoff, TX 75148-6202

Mailing address

1611 W Royall Blvd
Malakoff, TX 75148-6202
Phone (903) 489-1702

Other names 1

  • Cedar Lake Wellness & Rehabilitation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240314000317 TX Part A Provider - Skilled Nursing Facility 6002054764 Practice locations: Malakoff, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639945280. Details of each certification follow.

Skilled nursing facility certification: CCN 675898

Legal name
FANNIN COUNTY HOSPITAL AUTHORITY
Doing business as
CEDAR LAKE NURSING CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Nov 20, 2001
Last certification
Aug 7, 2024
Beds
90
Ownership / control type
Limited Liability Corporation
Organization structure
GovernmentNon-profit
Enrollment address
1611 W Royall Blvd
Malakoff, TX 75148-6202
Nursing home name
CEDAR LAKE NURSING CENTER
Affiliated entity
FANNIN COUNTY HOSPITAL DISTRICT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Cedar Lake Nursing CenterCCN 675898 · All quality measures
Overall star rating
3 of 5
Health inspections
5 of 5
Staffing
1 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Nov 20, 2001
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9052.8 residents per day on average
Chain
Fannin County Hospital District5 facilities in the chain
Penalties (3 years)
1Fines totaling $4,545

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
45D0478541Cedar Lake Nursing Center1611 West Royall Blvd, Malakoff, TX 75148Certificate of waiverFeb 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Fannin Cnty Hosp Authority72 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1611 W Royall Blvd
Malakoff, TX 75148
Phone (903) 489-1702

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Rusk Nursing & Rehab Center LLC Organization, Waco, TX LLC Operational/Managerial Control Jan 1, 2024 100%
Ursula a Bumpass Individual 5% Or Greater Mortgage InterestMember Jan 1, 2024 50%
Edward Blalock Individual Operational/Managerial ControlManager Jan 1, 2024
Adp of the SNF Jan 1, 2024
Mummm Investments, LLC Organization, Waco, TX LLC, Owned by another organization or individual 5% Or Greater Mortgage Interest Jan 1, 2024 100%
Adp of the SNF Jan 1, 2024
Michael Bumpass Individual 5% Or Greater Mortgage InterestMember Jan 1, 2024 50%
Adp of the SNF Jan 1, 2024
Clark R Sanderson Individual Corporate DirectorBoard President Jan 1, 2024
Fannin County Hospital Authority Organization, Bonham, TX 5% Or Greater Direct Ownership Interest Jan 1, 2024 100%
David Paul Sanner Individual Adp of the SNF Jan 1, 2024
Douglas Francis Humble Individual Adp of the SNF Jan 1, 2024

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 55

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
TMC Bonham HospitalBonham, TX, CCN 451370 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 2013
Jan 1, 2013
TMC Bonham HospitalBonham, TX, CCN 45Z370 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 2013
Reunion Plaza Senior Care and Rehabilitation CenterTexarkana, TX, CCN 675444 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 31, 2017
Heritage Plaza Nursing CenterTexarkana, TX, CCN 675561 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 31, 2017
Avir at AthensAthens, TX, CCN 455834 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 31, 2017
Wylie Oaks Healthcare and RehabilitationWylie, TX, CCN 676248 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
La Dora Nursing and Rehabilitation CenterBedford, TX, CCN 675934 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2026
Fannin County Hospital AuthorityParis, TX, CCN 676190 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Interlochen Health and Rehabilitation CenterArlington, TX, CCN 455835 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 31, 2017
Avir at the MeadowDallas, TX, CCN 455463 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 31, 2017
Pleasant Springs Healthcare CenterMt Pleasant, TX, CCN 455532 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 31, 2017
Longmeadow Healthcare CenterJustin, TX, CCN 675185 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2022
Texoma Healthcare CenterSherman, TX, CCN 455573 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 31, 2017
Downtown Health and Rehabilitation CenterFort Worth, TX, CCN 455651 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 31, 2017
North Park Health and Rehabilitation CenterMcKinney, TX, CCN 675196 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 31, 2017
Legend Oaks Healthcare and Rehabilitation-ParisParis, TX, CCN 676049 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Legend Oaks Healthcare and Rehabilitation-GladewaterGladewater, TX, CCN 676048 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Legend Oaks Healthcare and Rehabilitation-GreenvilleGreenville, TX, CCN 675774 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Park Highland Nursing & Rehabilitation CenterAthens, TX, CCN 675460 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 31, 2017
Ennis Care CenterEnnis, TX, CCN 455486 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018
Avir at JeffersonJefferson, TX, CCN 675241 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018
Trucare Living CentersPalestine, TX, CCN 676257 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2026
Veranda Rehabilitation and HealthcareHarlingen, TX, CCN 455925 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
Trucare Living Center-SelmaSelma, TX, CCN 676406 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2026
Village Healthcare and RehabilitationMcAllen, TX, CCN 675689 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2020
Avir at Walnut SpringsSeguin, TX, CCN 675656 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2020
Avir at KingslandKingsland, TX, CCN 676035 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2020
Avir at CenterCenter, TX, CCN 455550 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2021
The Waterton Healthcare and RehabilitationTyler, TX, CCN 676193 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2022
Harbor Valley Health and RehabilitationSan Antonio, TX, CCN 676478 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2026
Levelland Nursing and Rehabilitation CenterLevelland, TX, CCN 675329 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2022
Bangs Nursing and RehabilitationBangs, TX, CCN 675377 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2022
Pampa Nursing CenterPampa, TX, CCN 675327 Skilled nursing facility 5% Or Greater Direct Ownership Interest Apr 1, 2022
Greenview Nursing and RehabilitationWaco, TX, CCN 455638 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2022
Peach Tree PlaceWeatherford, TX, CCN 676148 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2022
The Park in PlanoPlano, TX, CCN 675113 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2022
Lakeshore Village Nursing and RehabilitationWaco, TX, CCN 675438 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2022
Avir at DallasDallas, TX, CCN 676215 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2022
Avir at WeatherfordWeatherford, TX, CCN 455574 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2022
Treasure Hills Healthcare and Rehabilitation CenterHarlingen, TX, CCN 675933 Skilled nursing facility 5% Or Greater Direct Ownership Interest Dec 1, 2023
Grand Terrace Rehabilitation and HealthcareMcAllen, TX, CCN 455586 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2023
McAllen Transitional Care CenterMcAllen, TX, CCN 676042 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2023
Alta Vista Rehabilitation and HealthBrownsville, TX, CCN 455625 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2024
Trucare Living Centers ColumbusColumbus, TX, CCN 676229 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2026
The Homestead of DenisonDenison, TX, CCN 675212 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2024
Bluebonnet Point WellnessBullard, TX, CCN 676494 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2024
Avir at Citizens TrailTexarkana, TX, CCN 675958 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jun 1, 2024
Jun 1, 2024
Woodlands Place Rehabilitation SuitesDenison, TX, CCN 676394 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2024
Belterra Health & RehabMcKinney, TX, CCN 676367 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2025
Greenbrier Nursing & Rehabilitation Center of PalestinePalestine, TX, CCN 675816 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2024
Crossroads Nursing & RehabilitationHearne, TX, CCN 676385 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2024
Countryview Nursing & RehabilitationTerrell, TX, CCN 675105 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2024
Windmill Village Rehabilitation & Care CenterLubbock, TX, CCN 676318 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2025
North Star Ranch Rehabilitation and Healthcare CenterBonham, TX, CCN 675471 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 May 1, 2025
May 1, 2025
May 1, 2025
Rockdale Estates & RehabilitationRockdale, TX, CCN 676093 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2025

Facilities with the same owner 55

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

View all 55

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": "1701043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786492800000",
    "number": "1639945280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 W ROYALL BLVD",
            "city": "MALAKOFF",
            "state": "TX",
            "postal_code": "751486202",
            "telephone_number": "903-489-1702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 W ROYALL BLVD",
            "city": "MALAKOFF",
            "state": "TX",
            "postal_code": "751486202",
            "telephone_number": "903-489-1702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANNIN COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-27",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A",
        "authorized_official_last_name": "SHEDDY",
        "authorized_official_first_name": "DENVER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "903-583-1854"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cedar Lake Wellness & Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Malakoff, TX

Sources for this page

Verify at the official NPI Registry.