LP Clarksville LLC
Organization Active NPI Nursing Facility/Intermediate Care Facility · Clarksville, TN
NPI 1891985131 · NPPES record last updated Apr 4, 2023
Key facts
- NPI
- 1891985131
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nursing Facility/Intermediate Care Facility 313M00000X
- License
- 191 (TN)
- Legal business name
- LP CLARKSVILLE LLC
- Practice address
- 198 Old Farmers Rd
Clarksville, TN 37043-4032 - Phone
- (931) 358-2900
- Fax
- (931) 358-3821
- NPI assigned
- Aug 1, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. John Harrison
- Title
- Cfo
- Phone
- (502) 568-7800
Facilities with the same owner 64
Practitioners 1
Affiliated clinicians 1
Medicare Care Compare: Nursing home
- Listed as
- Signature Healthcare of Clarksville
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★☆☆☆ 2 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Apr 1, 2002
- Medicare certification status
- Active
- Certified beds
- 120 · 92.1 residents per day on average
- Chain
- Signature Healthcare
- Penalties (3 years)
- 1 · fines totaling $63,105
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0946333 | LP Clarksville, LLC | Certificate of waiver | May 21, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Skilled nursing facility certification: CCN 445448
- Legal name
- LP CLARKSVILLE LLC
- Doing business as
- SIGNATURE HEALTHCARE OF CLARKSVILLE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Apr 1, 2002
- Last certification
- May 28, 2025
- Beds
- 120
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Signature Healthcare
- Organization structure
- LLC · Proprietary
- Incorporated
- Nov 8, 2006 in DE
- Enrollment address
- 198 Old Farmers Rd
Clarksville, TN 37043-4032 - Nursing home name
- SIGNATURE HEALTHCARE OF CLARKSVILLE
- Affiliated entity
- SIGNATURE HEALTHCARE
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Benjamin Crider |
W-2 Managing Employee |
Jan 16, 2024 | |
| Ira Smedra |
5% Or Greater Indirect Ownership Interest |
Nov 1, 2007 | 12% |
| SHC LP Holdings II LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2012 | 100% |
| Spring Holdings, LLC |
5% Or Greater Indirect Ownership Interest | May 1, 2018 | 100% |
| LP Re I Holdings LLC |
5% Or Greater Direct Ownership Interest | Nov 1, 2007 | 100% |
| Signature Healthcare LLC |
Other | Nov 1, 2007 | |
| Lpsnf LLC |
5% Or Greater Indirect Ownership Interest | Nov 1, 2007 | 74% |
| John H Harrison |
Corporate Officer |
Nov 1, 2007 | |
| Wheaten LLC |
5% Or Greater Indirect Ownership Interest | Nov 1, 2007 | 5% |
| Elmer Joseph Steier III |
5% Or Greater Indirect Ownership Interest |
Nov 1, 2007 | 20% |
| Jjla LLC |
5% Or Greater Indirect Ownership Interest | Nov 1, 2007 | 20% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071019000537 | TN | Part a Provider - Skilled Nursing Facility | 9234225384 | Practice locations: Clarksville, TN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | 191 | TN | Yes |
| Skilled Nursing Facility | 314000000X | 191 | TN |
Addresses
Primary practice location
198 Old Farmers Rd
Clarksville, TN 37043-4032
Mailing address
198 Old Farmers Rd
Clarksville, TN 37043-4032
Phone (931) 358-2900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0445448 | Medicaid | TN | |
| 7440143 | Medicaid | TN |
Other names
- Signature HealthCARE of Clarksville
Other providers in Clarksville, TN
- Reginald Shaw Lowe
- Tina Marie Lowe
- Zoe F Lowery
- Debra Lynn Lowrance
- Katelyn Loxley
- George E Lu
- Christopher J Lucas
- Cynthia Lucas
- Susan J Lukens
- Crystal Nicole Lulack
All providers in Clarksville, TN · Nursing Facility/Intermediate Care Facility in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 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.