Active NPI
Bradley County Nursing Home
- Nursing Facility/Intermediate Care Facility
- Cleveland, TN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Facility/Intermediate Care Facility
- Legal business name
- BRADLEY COUNTY NURSING HOME
- Practice address
- 2910 Peerless Rd NW
Cleveland, TN 37312-3742 - Phone
- (423) 472-7116
- NPI assigned
- Oct 11, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Joseph H Newcomb
- Title
- Administrator
- Phone
- (423) 472-7116
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | Primary |
Addresses
Primary practice location
2910 Peerless Rd NW
Cleveland, TN 37312-3742
Mailing address
2910 Peerless Rd NW
Cleveland, TN 37312-3742
Phone (423) 472-7116
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0345040001 | Other | TN | DEMERC/PALMETTO |
| 7440017 | Medicaid | TN | |
| 0345040001 | Other | TN | DME MAC JURISDICTION C |
| 0445141 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101203001164 | TN | Part A Provider - Skilled Nursing Facility | 9032306949 | Practice locations: Cleveland, TN |
Skilled nursing facility certification: CCN 445141
- Legal name
- BRADLEY COUNTY NURSING HOME
- Doing business as
- BRADLEY HEALTHCARE & REHABILITATION CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- May 22, 1981
- Last certification
- Nov 2, 2022
- Beds
- 213
- Ownership / control type
- Corporation
- Organization structure
- Not Selected
- Enrollment address
- 2910 Peerless Road NW
Cleveland, TN 37312-3742 - Nursing home name
- BRADLEY HEALTH CARE & REHAB
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Bradley Health Care & Rehab
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- May 22, 1981
- Medicare certification status
- Active
- Certified beds
- 213
- Penalties (3 years)
- 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0963567 | Bradley Healthcare & Rehabilitation | Certificate of waiver | Aug 2, 2027 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 9
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| John Stanbery | Corporate Officer | Mar 18, 2013 | |
| Dennis Burtnett | Corporate Officer | Apr 1, 2012 | |
| Erin Fuller | Corporate Officer | Jan 1, 2011 | |
| William Winters | Corporate Officer | Feb 1, 2011 | |
| Robert Rominger | Corporate Officer | Aug 1, 2012 | |
| Deborah Crabtree | W-2 Managing Employee | Mar 3, 2010 | |
| Sandra Jo Snider | Corporate Officer | Mar 18, 2013 | |
| Wendy Beck | Corporate Officer | Mar 18, 2013 | |
| Judy Gee | Corporate Officer | Mar 18, 2013 |
Owners & managing parties with NPI records 3
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Nurse Practitioner
- Cleveland, TN
- NPI 1851465439
Corporate Officer
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Cleveland, TN
- NPI 1013972538
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": "1128988800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1291161600000",
"number": "1801884010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2910 PEERLESS RD NW",
"city": "CLEVELAND",
"state": "TN",
"postal_code": "373123742",
"telephone_number": "423-472-7116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2910 PEERLESS RD NW",
"city": "CLEVELAND",
"state": "TN",
"postal_code": "373123742",
"telephone_number": "423-472-7116"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BRADLEY COUNTY NURSING HOME",
"organizational_subpart": "NO",
"enumeration_date": "2005-10-11",
"last_updated": "2010-12-01",
"status": "A",
"authorized_official_last_name": "NEWCOMB",
"authorized_official_first_name": "JOSEPH",
"authorized_official_middle_name": "H",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "423-472-7116",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "313M00000X",
"taxonomy_group": "",
"desc": "Nursing Facility/Intermediate Care Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEMERC/PALMETTO",
"identifier": "0345040001",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7440017",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DME MAC JURISDICTION C",
"identifier": "0345040001",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0445141",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Cleveland, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2010; 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.