LP Hodgenville LLC
Organization Active NPI Skilled Nursing Facility · Hodgenville, KY
NPI 1770865263 · NPPES record last updated Apr 3, 2023
Key facts
- NPI
- 1770865263
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 100277 (KY)
- Legal business name
- LP HODGENVILLE LLC
- Practice address
- 717 N Lincoln Blvd
Hodgenville, KY 42748-1622 - Phone
- (270) 358-3103
- NPI assigned
- Sep 12, 2011
- Organization subpart
- No
Authorized official
- Name
- John Harrison
- Title
- Cfo
- Phone
- (502) 568-7800
Facilities with the same owner 64
Practitioners 1
-
Leon Everett Butler Jr., M.D.
Affiliated clinicians 1
-
Leon Everett Butler Jr., M.D.
Medicare Care Compare: Nursing home
- Listed as
- Sunrise Manor Nursing Home
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Nov 14, 1967
- Medicare certification status
- Active
- Certified beds
- 137 · 126.6 residents per day on average
- Chain
- Signature Healthcare
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Skilled nursing facility certification: CCN 185057
- Legal name
- LP HODGENVILLE LLC
- Doing business as
- SUNRISE MANOR NURSING HOME
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 14, 1967
- Last certification
- Apr 14, 2022
- Beds
- 137
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Signature Healthcare
- Organization structure
- LLC · Proprietary
- Incorporated
- Apr 12, 2011 in DE
- Enrollment address
- 717 North Lincoln Blvd
Hodgenville, KY 42748-1622 - Nursing home name
- SUNRISE MANOR NURSING HOME
- Affiliated entity
- SIGNATURE HEALTHCARE
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Ira Smedra |
5% Or Greater Indirect Ownership Interest | Oct 1, 2011 | 12% |
| Amy Durbin |
W-2 Managing Employee |
Jun 13, 2023 | |
| Distinct Group Holdings, LLC |
5% Or Greater Direct Ownership Interest | May 1, 2018 | 100% |
| Signature Healthcare LLC |
Operational/Managerial Control | Oct 1, 2011 | |
| Lpsnf LLC |
5% Or Greater Indirect Ownership Interest | Oct 1, 2011 | 74% |
| John H Harrison |
Corporate Officer |
Oct 1, 2011 | |
| Wheaten LLC |
5% Or Greater Indirect Ownership Interest | Oct 1, 2011 | 5% |
| Elmer Joseph Steier III |
5% Or Greater Indirect Ownership Interest | Oct 1, 2011 | 20% |
| Corporate Officer |
Oct 1, 2011 | ||
| Operational/Managerial Control |
Apr 12, 2011 | ||
| Jjla LLC |
5% Or Greater Indirect Ownership Interest | Oct 1, 2011 | 20% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120214000837 | KY | Part a Provider - Skilled Nursing Facility | 6002088432 | Practice locations: Hodgenville, KY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Care Home Facility | 311ZA0620X | 750086 | KY | |
| Skilled Nursing Facility | 314000000X | |||
| Skilled Nursing Facility | 314000000X | 100277 | KY | Yes |
Addresses
Primary practice location
717 N Lincoln Blvd
Hodgenville, KY 42748-1622
Mailing address
717 N Lincoln Blvd
Hodgenville, KY 42748-1622
Phone (270) 358-3103
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100199630 | Medicaid | KY | |
| 7100194560 | Medicaid | KY |
Other names
- Sunrise Manor Nursing Home
Other providers in Hodgenville, KY
- Mariah Lavere
- Lincoln Trail District Health Department
- Lincoln Way LLC Janice Diane Haycraft Single MBR
- Louisville Optometric Centers, III PSC
- Louisville Optometric Centers, III PSC
- Kevin G Malison
- Midwest Psychologists, PLLC
- Jetona K Milby
- Susan D Mings
- Wesley Moore
All providers in Hodgenville, KY · Skilled Nursing Facility in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 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.