Humphreys County Care and Rehabilitation

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0000000135 Issued in TN

Legal business name

HUMPHREYS COUNTY CARE AND REHABILITATION

Practice address

104 Fort Hill Rd
Waverly, TN 37185-2128

Phone

(931) 296-2532

Fax

(931) 296-0829

NPI assigned

Jan 24, 2007

Last updated

Jan 5, 2026By 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

Janet A Pulley, LNHA

Title

Administrator

Phone

(931) 296-2532

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881749596. Details of each certification follow.

• CCN 445489 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 445489

Legal name

HUMPHREYS COUNTY CARE AND REHABILITATION

Doing business as

HUMPHREYS COUNTY CARE & REHAB

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 1, 2009

Last certification

Jun 5, 2024

Beds

91

Ownership / control type

Other Nonprofit

Organization structure

OtherNon-profit

Incorporated

Aug 15, 1990 in TN

Enrollment address

104 Fort Hill Rd
Waverly, TN 37185-2128

Nursing home name

HUMPHREYS COUNTY CARE AND REHABILITATION

Listed as

Humphreys County Care and RehabilitationCCN 445489 · All quality measures

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

3 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Other

Certified

Jan 1, 2009

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9169.6 residents per day on average

Penalties (3 years)

2Fines totaling $14,013

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 3

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

• George Thottakara Mathai, MD

  • Family Medicine Physician
  • New Johnsonville, TN
  • NPI 1316098858
  NPD (past)

Affiliated clinicians 2

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

• Lawrence Richard Jackson Jr., MD

  • Family Medicine Physician
  • Waverly, TN
  • NPI 1386794816

  Nursing home

  Care Compare affiliation
• George Thottakara Mathai, MD

  • Family Medicine Physician
  • New Johnsonville, TN
  • NPI 1316098858

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767571200000",
    "number": "1881749596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 FORT HILL RD",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371852128",
            "telephone_number": "931-296-2532",
            "fax_number": "931-296-0829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 FORT HILL RD",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371852128",
            "telephone_number": "931-296-2532",
            "fax_number": "931-296-0829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMPHREYS COUNTY CARE AND REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2026-01-05",
        "certification_date": "2026-01-05",
        "status": "A",
        "authorized_official_last_name": "PULLEY",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "931-296-2532",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "TN",
            "license": "0135",
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "TN",
            "license": "0000000135",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "0000000135",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla Hargrove
• Home Medical Care Inc (Health & Home)
• Tammy R. Hooper, LPN
• Amy Paulette Horton, PTA
• Humphreys County Board of Education
• Humphreys County Community Health Services Inc (Ascension Saint Thomas Three Rivers Primary Care)
• Humphreys County Community Health Services, Inc. (Ascension Saint Thomas Three Rivers)
• Humphreys County Community Health Services, Inc. (Ascension Saint Thomas Three Rivers)
• Lawrence Richard Jackson Jr., MD
• James Developmental Center Inc.

• Skilled Nursing Facility in Waverly, TN
• Providers in Waverly, 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 Jan 5, 2026; 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.