Jellico TN Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

JELLICO TN OPCO LLC

Practice address

240 Hospital LN
Jellico, TN 37762-4401

Phone

(423) 784-6626

NPI assigned

Feb 18, 2019

Organization subpart

No

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

Authorized official

Name

David Herskowitz

Title

Ceo

Phone

(212) 444-1991

Specialties & licenses 1

Addresses

Other names 1

• Beech Tree Health and Rehabilitation Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Skilled nursing facility certification: CCN 445292

Legal name

JELLICO TN OPCO LLC

Doing business as

BEECH TREE POST ACUTE AND REHABILITATION CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jul 2, 1992

Last certification

Apr 11, 2024

Beds

110

Ownership / control type

Limited Liability Corporation

Multi-facility organization

Plainview Healthcare

Most recent change of ownership

May 1, 2009

Organization structure

LLCProprietary

Incorporated

Jan 3, 2019 in DE

Enrollment address

240 Hospital LN
Jellico, TN 37762-4401

Nursing home name

BEECH TREE HEALTH AND REHABILITATION

Affiliated entity

PLAINVIEW HEALTHCARE PARTNERS

Listed as

Beech Tree Health and RehabilitationCCN 445292

Overall star rating

1 of 5

Health inspections

1 of 5

Staffing

2 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jul 2, 1992

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

11099.5 residents per day on average

Chain

Plainview Healthcare Partners9 facilities in the chain

Special focus status

SFF Candidate

Abuse citation

Cited for abuse (Care Compare abuse icon)

Penalties (3 years)

2Fines totaling $138,802

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 7

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.

• Ruhul Ahmed Choudhury, MD

  • Internal Medicine Physician
  • Williamsburg, KY
  • NPI 1871531889

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Darryl John Wilkens, M.D.

  • Family Medicine Physician
  • Jellico, TN
  • NPI 1679678429
  NPD (past)
• Ruhul Ahmed Choudhury, MD

  • Internal Medicine Physician
  • Williamsburg, KY
  • NPI 1871531889
  NPD (past)

Affiliated clinicians 3

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

• Darryl John Wilkens, M.D.

  • Family Medicine Physician
  • Jellico, TN
  • NPI 1679678429

  Nursing home

  Care Compare affiliation
• Ruhul Ahmed Choudhury, MD

  • Internal Medicine Physician
  • Williamsburg, KY
  • NPI 1871531889

  Nursing home

  Care Compare affiliation
• James Wendall Killian, M.D.

  • Family Medicine Physician
  • Williamsburg, KY
  • NPI 1649273467

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1550448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1770049504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2071 FLATBUSH AVE STE 12",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112344340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 HOSPITAL LN",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377624401",
            "telephone_number": "423-784-6626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JELLICO TN OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-18",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "HERSKOWITZ",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "212-444-1991"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beech Tree Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beech Tree Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jellico Regional Hospital, LLC
• Jellico Regional Hospital, LLC
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• Jellico Regional Hospital, LLC
• Jellico Surgery Center, LLC
• Jellico Wellness and Convenient Care Clinic, LLC
• JLC Beechtree Inc
• Kabir Clinic LLC
• Mohammed Humayun Kabir, MD
• Suzanne Musick Kitts, PHARMD

• Skilled Nursing Facility in Jellico, TN
• Providers in Jellico, TN by specialty
• Skilled Nursing Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.