Maple Grove Senior Living LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

MAPLE GROVE SENIOR LIVING LLC

Practice address

711 Frankfort Rd
Shelbyville, KY 40065-9447

Phone

(502) 633-3486

NPI assigned

Aug 26, 2024

Last updated

Aug 26, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Douglas P Cox

Title

Trustee

Phone

(615) 478-6181

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871326710. Details of each certification follow.

• CCN 185378 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 185378

Legal name

MAPLE GROVE SENIOR LIVING LLC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Apr 28, 1993

Last certification

Aug 1, 2024

Beds

117 (90 certified)

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Enrollment address

711 Frankfort Rd
Shelbyville, KY 40065-9447

Nursing home name

MAPLE GROVE SENIOR LIVING LLC

Affiliated entity

ECC TRUST

Listed as

Maple Grove Senior Living LLCCCN 185378 · All quality measures

Overall star rating

3 of 5

Health inspections

3 of 5

Staffing

4 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Apr 28, 1993

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9074.5 residents per day on average

Chain

Ecc Trust3 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Locations

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.

• Laura Faughn, M.D.

  • Family Medicine Physician
  • Lexington, KY
  • NPI 1861519241

  Adp of the SNF

  CMS ownership

Facilities with the same owner 3

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

• Providence Point Healthcare, Inc.

  dba Providence Pointe Healthcare

  • Skilled Nursing Facility
  • Paducah, KY
  • NPI 1578163697

  Ecc Trust

  CMS ownership
• Ewv Holdings, LLC

  dba Elizabeth Care Center

  • Skilled Nursing Facility
  • Elizabeth, WV
  • NPI 1437785623

  Ecc Trust

  CMS ownership
• Ironton Opco, Inc.

  dba Harbor Healthcare of Ironton

  • Skilled Nursing Facility
  • Ironton, OH
  • NPI 1003341355

  Ecc Trust

  CMS ownership

Practitioners 1

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.

• Laura Faughn, M.D.

  • Family Medicine Physician
  • Lexington, KY
  • NPI 1861519241
  NPD (past)

Affiliated clinicians 2

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

• Laura Faughn, M.D.

  • Family Medicine Physician
  • Lexington, KY
  • NPI 1861519241

  Nursing home

  Care Compare affiliation
• Lisa D Miller, MD

  • Internal Medicine Physician
  • Leitchfield, KY
  • NPI 1538154687

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1724630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724630400000",
    "number": "1871326710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 INDUSTRIAL DR",
            "city": "WHITE HOUSE",
            "state": "TN",
            "postal_code": "371888150",
            "telephone_number": "615-478-6181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 FRANKFORT RD",
            "city": "SHELBYVILLE",
            "state": "KY",
            "postal_code": "400659447",
            "telephone_number": "502-633-3486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE GROVE SENIOR LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-26",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "TRUSTEE",
        "authorized_official_telephone_number": "615-478-6181"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John T Mahan, MD
• Caitin Mann
• Leslie Ann Mann, MS, OTR/L
• Faiyad Yaseer Mannan, MD
• Richard Manuel, RPH
• Jessica Rae Marshall, L.M.T.
• Kenneth Edwin Marshall, MD
• Amy L Martin
• Ashlyn Delaney Martin, PA-C
• Frank J Martin, M.D.

• Skilled Nursing Facility in Shelbyville, KY
• Providers in Shelbyville, KY by specialty
• Skilled Nursing Facility in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; 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.