NPIMap

Organization Active NPI

Alexian Village of Tennessee

Doing business as Ascension Living Alexian Village Tennessee

  • Skilled Nursing Facility
  • Signal Mountain, TN
National Provider Identifier
1730164583
Registry record updated Jun 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
102 Issued in TN
Legal business name
ALEXIAN VILLAGE OF TENNESSEE
Doing business as
Ascension Living Alexian Village Tennessee
Practice address
437 Alexian Way
Signal Mountain, TN 37377-1954
Phone
(423) 886-0100
NPI assigned
Dec 14, 2005
Last updated
Jun 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2025

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

Authorized official

Name
Erin Shadbolt
Title
Ceo
Phone
(314) 729-3500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 102 TN
Skilled Nursing Facility 314000000X 102 TN Primary

Addresses

Primary practice location

437 Alexian Way
Signal Mountain, TN 37377-1954

Mailing address

437 Alexian Way
Signal Mountain, TN 37377-1954

Other identifiers 2

IdentifierTypeStateIssuer
7440001MedicaidTN
0445123MedicaidTN

Other names 1

  • ASCENSION LIVING ALEXIAN VILLAGE TENNESSEE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120203000239 TN Part A Provider - Skilled Nursing Facility 7012174964 Practice locations: Signal Mountain, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730164583. Details of each certification follow.

Skilled nursing facility certification: CCN 445123

Legal name
ALEXIAN VILLAGE OF TENNESSEE
Doing business as
ASCENSION LIVING ALEXIAN VILLAGE TENNESSEE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 1, 1978
Last certification
Sep 25, 2024
Beds
114
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Accension Healthcare
Organization structure
CorporationNon-profit
Incorporated
Mar 19, 1980 in TN
Enrollment address
437 Alexian Way
Signal Mountain, TN 37377-1954
Nursing home name
ASCENSION LIVING ALEXIAN VILLAGE TENNESSEE
Affiliated entity
ASCENSION LIVING

Care Compare: Nursing home

Medicare Care Compare
Listed as
Ascension Living Alexian Village TennesseeCCN 445123 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jun 1, 1978
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
11489.1 residents per day on average
Chain
Ascension Living12 facilities in the chain
Penalties (3 years)
3Fines totaling $226,846

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

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
Health Dimensions Consulting Inc Organization, Minneapolis, MN Corporation, Medical staffing company Adp of the SNF Aug 2, 2019
House Healthcare Solutions LLC Organization, Rockford, IL Corporation, Medical staffing company Adp of the SNF Jun 10, 2025
Gregory Nieckula Individual Operational/Managerial Control Nov 1, 2017
Adp of the SNF Nov 1, 2017
The Rose Group, Inc Organization, Gainesville, FL Corporation, Medical staffing company Adp of the SNF Jun 16, 2025
Ascension Health Senior Care Organization, Saint Louis, MO Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2014 100%
Adp of the SNF Jul 1, 2015
Teddie Simmons Individual Operational/Managerial Control Mar 28, 2025
Adp of the SNF Mar 28, 2025
Medical Solutions LLC Organization, Omaha, NE LLC, Medical staffing company Adp of the SNF Jun 16, 2025
Lisa Musgrave Individual Corporate OfficerSVP Post Acute Care Jan 1, 2024
Adp of the SNF Jan 1, 2024
Erin Shadbolt Individual Corporate DirectorChief Executive Officer Jan 1, 2024
Adp of the SNF Jan 1, 2024

Owners & managing parties with NPI records 2

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

Facilities with the same owner 13

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

View all 13

Practitioners & affiliated clinicians

Affiliated clinicians 6

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": "1134518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750636800000",
    "number": "1730164583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "437 ALEXIAN WAY",
            "city": "SIGNAL MOUNTAIN",
            "state": "TN",
            "postal_code": "373771954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "437 ALEXIAN WAY",
            "city": "SIGNAL MOUNTAIN",
            "state": "TN",
            "postal_code": "373771954",
            "telephone_number": "423-886-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEXIAN VILLAGE OF TENNESSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-14",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A",
        "authorized_official_last_name": "SHADBOLT",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "314-729-3500"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "TN",
            "license": "102",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7440001",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0445123",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ASCENSION LIVING ALEXIAN VILLAGE TENNESSEE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Signal Mountain, TN

Sources for this page

Verify at the official NPI Registry.