Village of Lebanon II, LLC

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

100646 Issued in KY

Legal business name

VILLAGE OF LEBANON II, LLC

Practice address

105 Village Way
Lebanon, KY 40033-1845

Phone

(270) 692-9000

Fax

(270) 699-3691

NPI assigned

May 9, 2007

Last updated

Apr 27, 2018By 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

Tim B George

Title

Manager

Phone

(502) 751-6823

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649484015. Details of each certification follow.

• CCN 185437 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 185437

Legal name

VILLAGE OF LEBANON II, LLC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF distinct part

Participating since

Oct 2, 1997

Last certification

Apr 21, 2022

Beds

107 (64 certified)

Ownership / control type

Partnership

Organization structure

LLCProprietary

Incorporated

Feb 5, 2004 in KY

Enrollment address

105 Village Way
Lebanon, KY 40033-1845

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• David Brian George, M.D.

  • Internal Medicine Physician
  • Lebanon, KY
  • NPI 1376525212

  I20040415000015

  Same enrollment

Listed as

Village of LebanonCCN 185437 · All quality measures

Overall star rating

2 of 5

Health inspections

3 of 5

Quality measures

1 of 5

Type

Medicare and Medicaid

Ownership

For profit - Partnership

Certified

Oct 2, 1997

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

64

Penalties (3 years)

8Fines totaling $45,335

Processed by Care Compare on Aug 1, 2026.

Locations

All disclosed owners & managing parties 6

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

Owners & managing parties with NPI records 1

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

• David Brian George, M.D.

  • Internal Medicine Physician
  • Lebanon, KY
  • NPI 1376525212

  5% Or Greater Direct Ownership Interest

  CMS ownership

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.

• David Brian George, M.D.

  • Internal Medicine Physician
  • Lebanon, KY
  • NPI 1376525212
  NPD
• Leon Everett Butler Jr., M.D.

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1689754822
  NPD (past)
• Dennis C. Simms, M.D.

  • Family Medicine Physician
  • Loretto, KY
  • NPI 1871587485
  NPD (past)

Affiliated clinicians 5

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

• Julia Keeling Brown, MD

  • Internal Medicine Physician
  • Springfield, KY
  • NPI 1669459434

  Nursing home

  Care Compare affiliation
• David Brian George, M.D.

  • Internal Medicine Physician
  • Lebanon, KY
  • NPI 1376525212

  Nursing home

  Care Compare affiliation
• William Deadrick Kirk, M.D.

  • Internal Medicine Physician
  • Lebanon, KY
  • NPI 1972595270

  Nursing home

  Care Compare affiliation
• Michelle Jo Leathers, M.D.

  • Family Medicine Physician
  • Lebanon, KY
  • NPI 1093797185

  Nursing home

  Care Compare affiliation
• Alexander Bancroft George, MD

  • Internal Medicine Physician
  • Indianapolis, IN
  • NPI 1124552559

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524787200000",
    "number": "1649484015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 VILLAGE WAY",
            "city": "LEBANON",
            "state": "KY",
            "postal_code": "400331845",
            "telephone_number": "270-692-9000",
            "fax_number": "270-699-3691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 VILLAGE WAY",
            "city": "LEBANON",
            "state": "KY",
            "postal_code": "400331845",
            "telephone_number": "270-692-9000",
            "fax_number": "270-699-3691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE OF LEBANON II, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2018-04-27",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "TIM",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "502-751-6823"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "KY",
            "license": "100646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100236520",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Derhonda Mae Thompson, APRN
• Lindsey Gritton Thompson, LPCC
• Sarah Beth Thompson, LPCC
• Brittany Nicole Tyler, PHARMD
• Dariann Nicole Updike, M.ED., LPCC, PBSS
• VL Opco LLC (Village of Lebanon)
• VMD Primary Providers Central Kentucky (Village Medical)
• VMD Primary Providers Central Kentucky
• Michelle Waddles Crimes
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1675)

• Nursing Facility/Intermediate Care Facility in Lebanon, KY
• Providers in Lebanon, KY by specialty
• Nursing Facility/Intermediate Care Facility in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2018; 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.