NPIMap

Organization Active NPI

South Limestone Hospital District

Doing business as Providence Park Rehabilitation and Skilled Nursing

  • Skilled Nursing Facility
  • Tyler, TX
National Provider Identifier
1770752172
Registry record updated Apr 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
124617 Issued in TX
Legal business name
SOUTH LIMESTONE HOSPITAL DISTRICT
Doing business as
Providence Park Rehabilitation and Skilled Nursing
Practice address
5505 New Copeland Rd
Tyler, TX 75703-3955
Phone
(903) 939-2443
Fax
(903) 939-2479
NPI assigned
Feb 29, 2008
Last updated
Apr 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2020

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

Authorized official

Name
Larry N. Price
Title
Ceo
Phone
(254) 729-3281

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 124617 TX Primary

Addresses

Primary practice location

5505 New Copeland Rd
Tyler, TX 75703-3955

Mailing address

1500 Waters Ridge Dr Ste 200
Lewisville, TX 75057-6056
Phone (214) 899-4126

Other identifiers 2

IdentifierTypeStateIssuer
001021325MedicaidTX
197010501OtherTXMCD CO B

Other names 1

  • Providence Park Rehabilitation and Skilled Nursing Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200513000998 TX Part A Provider - Skilled Nursing Facility 9032103700 Practice locations: Tyler, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770752172. Details of each certification follow.

Skilled nursing facility certification: CCN 676184

Legal name
SOUTH LIMESTONE HOSPITAL DISTRICT
Doing business as
PROVIDENCE PARK REHABILITATION AND SKILLED NURSING
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jul 24, 2008
Last certification
May 8, 2024
Beds
125
Ownership / control type
Corporation
Organization structure
GovernmentNon-profit
Incorporated
Jun 20, 1970 in TX
Enrollment address
5505 New Copeland Rd
Tyler, TX 75703-3955
Nursing home name
PROVIDENCE PARK REHABILITATION AND SKILLED NURSING
Affiliated entity
STONEGATE SENIOR LIVING

Care Compare: Nursing home

Medicare Care Compare
Listed as
Providence Park Rehabilitation and Skilled NursingCCN 676184 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jul 24, 2008
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
125104.2 residents per day on average
Chain
Stonegate Senior Living24 facilities in the chain
Penalties (3 years)
2Fines totaling $188,361

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Member organizations 5

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
John T McKeehan Individual Operational/Managerial Control Sep 18, 2023
Adp of the SNF Sep 18, 2023
David D Larsen Individual Adp of the SNF Nov 20, 2024
Larry N Price Individual Corporate OfficerChief Executive Officer Jun 1, 1982
Shannon Nichole Dillon Individual Adp of the SNF Apr 12, 2023
Lifetime Wellness, LTD. Organization, Tyler, TX Adp of the SNF Sep 23, 2021
Martus Financial Services, Inc. Organization, Justin, TX Corporation, For-profit Adp of the SNF Dec 31, 2023
Rehab Pro LP Organization, Tyler, TX Adp of the SNF Sep 23, 2021
Umb Bank National Association Organization, Dallas, TX Financial institution, Owned by another organization or individual 5% Or Greater Mortgage Interest Sep 23, 2021 100%
Sanctuary LTC, LLC Organization, Lewisville, TX LLC, For-profit Adp of the SNF Sep 23, 2021
PF Broadmore SNF Ops, LLC Organization, Lewisville, TX LLC, For-profit Operational/Managerial Control Sep 23, 2021
Adp of the SNF Dec 3, 2025
South Limestone Hospital District Organization, Groesbeck, TX 5% Or Greater Direct Ownership Interest Apr 1, 2020 100%
Stonegate Senior Living, LP Organization, Lewisville, TX Operational/Managerial Control Jun 22, 2022
Adp of the SNF Dec 3, 2025
Pharmerica Drug Systems LLC Organization, Louisville, KY LLC Adp of the SNF Aug 27, 2017
Preservation Freehold Company Organization, Lewisville, TX Corporation, Non-profit Adp of the SNF Sep 23, 2021

Owners & managing parties with NPI records 17

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

View all 17

All facility ownership & control disclosures 30

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Limestone Medical CenterGroesbeck, TX, CCN 451303 Hospital Operational/Managerial Control (14%) Aug 5, 1996
Limestone Medical CenterGroesbeck, TX, CCN 45Z303 Hospital Operational/Managerial Control Aug 5, 1996
Accel at Willow BendPlano, TX, CCN 676349 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 27, 2015
Garnet Hill Rehabilitation and Skilled CareWylie, TX, CCN 676192 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 27, 2015
Settlers Ridge Care CenterCelina, TX, CCN 675969 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 27, 2015
The Villages on MacarthurIrving, TX, CCN 676358 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 27, 2015
Baybrooke Village Care and Rehab CenterMcKinney, TX, CCN 676096 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 27, 2015
Woodland Springs Nursing CenterWaco, TX, CCN 675360 Skilled nursing facility Operational/Managerial Control (50%) Jan 23, 2015
Georgetown Nursing and Transitional CareGeorgetown, TX, CCN 676280 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 1, 2017
Sep 30, 2025
Creekside Terrace RehabilitationBelton, TX, CCN 455497 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
San Gabriel Rehabilitation and Care CenterRound Rock, TX, CCN 676308 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Groesbeck LTC Nursing and RehabilitationGroesbeck, TX, CCN 676071 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018
Teague Nursing and RehabilitationTeague, TX, CCN 675884 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018
Mexia LTC Nursing and RehabilitationMexia, TX, CCN 675903 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Apr 1, 2018
Apr 23, 2025
Falcon Ridge RehabilitationHutto, TX, CCN 676382 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2019
Briarcliff Health CenterTyler, TX, CCN 675142 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2019
Chandler Health CareChandler, TX, CCN 455910 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2019
Avir at BeltonBelton, TX, CCN 675948 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2021
Van HealthcareVan, TX, CCN 455856 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2022
Panola County Nursing & RehabilitationCarthage, TX, CCN 675387 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 15, 2024
Crimson Heights Health & WellnessHumble, TX, CCN 676463 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2024
Terra Bella Health and Wellness SuitesHouston, TX, CCN 676450 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2024
St. Joseph's Care CenterMcGregor, TX, CCN 745059 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2024
The Chateau WacoWaco, TX, CCN 676409 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2025
Avir at CorsicanaCorsicana, TX, CCN 676295 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2025
St. Anthony's Care CenterWaco, TX, CCN 676462 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2025
West Rest HavenWest, TX, CCN 676386 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2025
Rettig Family Health Care a Limestone Medical Center ClinicGroesbeck, TX, CCN 673480 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2015
Kosse Community Health Clinic a Limestone Medical Center ClinicKosse, TX, CCN 673482 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2015
Family Medicine CenterGroesbeck, TX, CCN 453984 Rural health clinic Operational/Managerial Control Mar 28, 2022

Facilities with the same owner 48

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

View all 48

Practitioners & affiliated clinicians

Practitioners 5

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 1

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": "1204243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586131200000",
    "number": "1770752172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 WATERS RIDGE DR STE 200",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750576056",
            "telephone_number": "214-899-4126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5505 NEW COPELAND RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033955",
            "telephone_number": "903-939-2443",
            "fax_number": "903-939-2479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LIMESTONE HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-29",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "254-729-3281"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "124617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001021325",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCD CO B",
            "identifier": "197010501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Park Rehabilitation and Skilled Nursing",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Park Rehabilitation and Skilled Nursing",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.