NPIMap

Organization Active NPI

Williamsburg Nursing Home, Inc.

Doing business as Williamsburg Nursing Home

  • Skilled Nursing Facility
  • Williamsburg, KY
National Provider Identifier
1750493151
Registry record updated May 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
100488 Issued in KY
Legal business name
WILLIAMSBURG NURSING HOME, INC.
Doing business as
Williamsburg Nursing Home
Practice address
287 N 11TH St
Williamsburg, KY 40769-1759
Phone
(606) 549-4321
Fax
(606) 549-4324
NPI assigned
Aug 31, 2006
Last updated
May 7, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
FIRST CORBIN LONG TERM CARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 7, 2008

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

Authorized official

Name
Mr. Terry Emanuel Forcht
Title
Chairman
Phone
(606) 528-9600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 100488 KY Primary

Addresses

Primary practice location

287 N 11TH St
Williamsburg, KY 40769-1759

Mailing address

PO Box 719
Williamsburg, KY 40769-0719
Phone (606) 549-4321

Other identifiers 2

IdentifierTypeStateIssuer
12500344MedicaidKY
000000054731OtherKYANTHEM BCBS

Other names 1

  • Williamsburg Nursing Home Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20020913000016 KY Part A Provider - Skilled Nursing Facility 3870400609 Practice locations: Williamsburg, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750493151. Details of each certification follow.

Skilled nursing facility certification: CCN 185148

Legal name
WILLIAMSBURG NURSING HOME, INC.
Doing business as
WILLIAMSBURG HEALTH & REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 12, 1978
Last certification
Oct 24, 2024
Beds
125
Ownership / control type
Individual
Organization structure
CorporationProprietary
Incorporated
Feb 17, 1976 in KY
Enrollment address
287 N 11TH St
Williamsburg, KY 40769-1759
Nursing home name
WILLIAMSBURG HEALTH & REHABILITATION CENTER
Affiliated entity
SEKY HOLDING CO.

Care Compare: Nursing home

Medicare Care Compare
Listed as
Williamsburg Health & Rehabilitation CenterCCN 185148 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
Apr 12, 1978
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
125101.7 residents per day on average
Chain
Seky Holding Co.9 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
18D0705414Williamsburg Nursing Home, Inc D/B/a287 North 11TH Street, Williamsburg, KY 40769Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

287 N 11th St
Williamsburg, KY 40769
Phone (606) 549-4321

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Terry E Forcht Individual 5% Or Greater Indirect Ownership Interest Jun 18, 2003 98.51%
John Dailey Individual Operational/Managerial ControlManager May 6, 2018
Roger Alsip Individual Corporate OfficerTreasurer Jan 1, 2011
Corporate DirectorTreasurer and Director Aug 6, 2018
Fcltc Holdings Inc Organization, Corbin, KY Corporation, For-profit 5% Or Greater Indirect Ownership Interest Apr 28, 2016 100%
Maria C Atienza Individual Contracted Managing EmployeeMD; Aug 25, 2012
David Witt Individual Corporate OfficerSecretary Jan 1, 2011
Corporate DirectorSecretary and Director Aug 6, 2018
Jackie Willis Individual Corporate OfficerAssistant Secretary Jan 1, 2011
Laura Creekmore Individual W-2 Managing EmployeeAdministrator Aug 18, 2016
Operational/Managerial ControlAdministrator Aug 18, 2016
Wesley Tipton Individual Corporate OfficerPresident/Chairman May 16, 2018
Corporate DirectorPresident/Chairman/Director Jun 20, 2016
Seky Holding Co Organization, Corbin, KY Created for acquisition, Corporation, For-profit 5% Or Greater Direct Ownership Interest Mar 13, 2003 100%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 8

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

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 2

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": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210118400000",
    "number": "1750493151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 719",
            "city": "WILLIAMSBURG",
            "state": "KY",
            "postal_code": "407690719",
            "telephone_number": "606-549-4321",
            "fax_number": "606-549-4324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "287 N 11TH ST",
            "city": "WILLIAMSBURG",
            "state": "KY",
            "postal_code": "407691759",
            "telephone_number": "606-549-4321",
            "fax_number": "606-549-4324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSBURG NURSING HOME, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIRST CORBIN LONG TERM CARE, INC.",
        "enumeration_date": "2006-08-31",
        "last_updated": "2008-05-07",
        "status": "A",
        "authorized_official_last_name": "FORCHT",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "EMANUEL",
        "authorized_official_title_or_position": "CHAIRMAN",
        "authorized_official_telephone_number": "606-528-9600",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "KY",
            "license": "100488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12500344",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000054731",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Williamsburg Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamsburg, KY

Sources for this page

Verify at the official NPI Registry.