LP Memphis V, LLC
Organization Active NPI Skilled Nursing Facility · Memphis, TN
NPI 1760898415 · NPPES record last updated Apr 4, 2023
Key facts
- NPI
- 1760898415
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- LP MEMPHIS V, LLC
- Practice address
- 6025 Primacy Pkwy
Memphis, TN 38119-5763 - Phone
- (901) 767-1040
- Fax
- (901) 685-7362
- NPI assigned
- Jul 2, 2014
- Organization subpart
- No
Authorized official
- Name
- John Harrison
- Title
- Cfo
- Phone
- (502) 568-7800
Facilities with the same owner 67
Practitioners 2
-
Angela D Watson, DO
Affiliated clinicians 1
-
Angela D Watson, DO
Medicare Care Compare: Nursing home
- Listed as
- Signature Healthcare of Primacy
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★★☆ 4 of 5
- Staffing
- ★★☆☆☆ 2 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jun 3, 1981
- Medicare certification status
- Active
- Certified beds
- 120 · 97.4 residents per day on average
- Chain
- Signature Healthcare
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0314729 | LP Memphis V, LLC | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Skilled nursing facility certification: CCN 445140
- Legal name
- LP MEMPHIS V, LLC
- Doing business as
- SIGNATURE HEALTHCARE OF PRIMACY
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jun 3, 1981
- Last certification
- Dec 1, 2021
- Beds
- 120
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Signature Healthcare
- Organization structure
- LLC · Proprietary
- Incorporated
- Jun 16, 2014 in DE
- Enrollment address
- 6025 Primacy Parkway
Memphis, TN 38119-5763 - Nursing home name
- SIGNATURE HEALTHCARE OF PRIMACY
- Affiliated entity
- SIGNATURE HEALTHCARE
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Ira Smedra |
5% Or Greater Indirect Ownership Interest | Nov 1, 2014 | 12% |
| Asbr Holdings LLC |
5% Or Greater Indirect Ownership Interest | May 1, 2018 | 100% |
| Signature Healthcare LLC |
Other | Nov 1, 2014 | |
| SHC LP Holdings LLC |
5% Or Greater Direct Ownership Interest | Nov 1, 2014 | 100% |
| Lpsnf LLC |
5% Or Greater Indirect Ownership Interest | Nov 1, 2014 | 74% |
| John H Harrison |
Corporate Officer |
Oct 1, 2014 | |
| Wheaten LLC |
5% Or Greater Indirect Ownership Interest | Nov 1, 2014 | 5% |
| Charla B Scott |
W-2 Managing Employee |
May 28, 2024 | |
| Elmer Joseph Steier III |
5% Or Greater Indirect Ownership Interest |
Nov 1, 2014 | 20% |
| Jjla LLC |
5% Or Greater Indirect Ownership Interest | Nov 1, 2014 | 20% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140721001578 | TN | Part a Provider - Skilled Nursing Facility | 4082830492 | Practice locations: Memphis, TN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
6025 Primacy Pkwy
Memphis, TN 38119-5763
Mailing address
12201 Bluegrass Pkwy
Louisville, KY 40299-2361
Phone (502) 568-7800
Other names
- Signature HealthCARE of Primacy
Other providers in Memphis, TN
- Amy Lorraine Lowry
- Micah Loyd
- Tamia Marie Lozada Soto
- LP Memphis II, LLC
- LP Memphis LLC
- LS of Memphis, PC
- LS Transports You, LLC
- Evelyn Lu
- Feng Lu
- Ashley Lucas
All providers in Memphis, TN · Skilled Nursing Facility in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.