Active NPI
LP Louisville South LLC
Doing business as Signature HealthCARE of South Louisville
- Skilled Nursing Facility
- Louisville, KY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 100452
- Legal business name
- LP LOUISVILLE SOUTH LLC
- Doing business as
- Signature HealthCARE of South Louisville
- Practice address
- 1120 Cristland Rd
Louisville, KY 40214-4150 - Phone
- (502) 367-0104
- Fax
- (502) 368-5208
- NPI assigned
- Aug 5, 2007
- Last updated
- Apr 4, 2023
- Organization subpart
- Yes
- Parent organization
- LP CR HOLDINGS LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. John Harrison
- Title
- Cfo
- Phone
- (502) 568-7800
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 100452 | KY | Primary |
Addresses
Primary practice location
1120 Cristland Rd
Louisville, KY 40214-4150
Mailing address
12201 Bluegrass Pkwy
Louisville, KY 40299-2361
Phone (502) 568-7800
Other names 1
- Signature HealthCARE of South Louisville
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070914000267 | KY | Part A Provider - Skilled Nursing Facility | 8729172242 | Practice locations: Louisville, KY |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1891986170. Details of each certification follow.
Skilled nursing facility certification: CCN 185335
- Legal name
- LP LOUISVILLE SOUTH LLC
- Doing business as
- SIGNATURE HEALTHCARE OF SOUTH LOUISVILLE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Feb 29, 1992
- Last certification
- Jan 23, 2025
- Beds
- 100
- Ownership / control type
- Corporation
- Multi-facility organization
- Signature Healthcare
- Organization structure
- LLC
- Incorporated
- Nov 8, 2006 in DE
- Enrollment address
- 1120 Cristland Rd
Louisville, KY 40214-4150 - Nursing home name
- SIGNATURE HEALTHCARE OF SOUTH LOUISVILLE
- Affiliated entity
- SIGNATURE HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Signature Healthcare of South Louisville
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Feb 29, 1992
- Medicare certification status
- Active
- Certified beds
- 100
- Chain
- Signature Healthcare
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 |
|---|---|---|---|
| 18D0321580 | LP Louisville South, LLC Dba | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 10
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 |
|---|---|---|---|
| Tyra Little | W-2 Managing Employee | Oct 30, 2023 | |
| Ira Smedra | 5% Or Greater Indirect Ownership Interest | Nov 1, 2007 | 12% |
| Agemo Holdings LLC | 5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 100% |
| Lpsnf II LLC | 5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 74% |
| Signature Healthcare LLC | Operational/Managerial Control | May 7, 2018 | |
| 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% |
| LP CR Holdings LLC | 5% Or Greater Direct Ownership Interest | Nov 1, 2007 | 100% |
| Jjla LLC | 5% Or Greater Indirect Ownership Interest | Nov 1, 2007 | 20% |
Facilities with the same owner 64
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Clinton County Care & Rehabilitation Center
- Skilled Nursing Facility
- Albany, KY
- NPI 1437340700
Agemo Holdings LLC, Jjla LLC, Lpsnf II LLC, Wheaten LLC
-
dba Signature Healthcare at Jackson Manor Rehab & Wellness Center
- Skilled Nursing Facility
- Annville, KY
- NPI 1760853725
Jjla LLC, Wheaten LLC
-
dba Signature Healthcare at Colonial Rehab & Wellness Center
- Skilled Nursing Facility
- Bardstown, KY
- NPI 1548631070
Jjla LLC, Wheaten LLC
-
dba Lee County Care & Rehabilitation Center
- Skilled Nursing Facility
- Beattyville, KY
- NPI 1255522520
Agemo Holdings LLC, Jjla LLC, LP CR Holdings LLC, Lpsnf II LLC, Signature Healthcare LLC, Wheaten LLC
-
dba Signature HealthCARE of Bowling Green
- Skilled Nursing Facility
- Bowling Green, KY
- NPI 1447674437
Jjla LLC, Wheaten LLC
-
dba Rockcastle Health and Rehabilitation Center
- Skilled Nursing Facility
- Brodhead, KY
- NPI 1609053735
Jjla LLC, Wheaten LLC
-
dba Riverside Care & Rehabilitation Center
- Skilled Nursing Facility
- Calhoun, KY
- NPI 1932523602
Jjla LLC, Wheaten LLC
-
dba Oakview Nursing & Rehabilitation Center
- Skilled Nursing Facility
- Calvert City, KY
- NPI 1619218385
Jjla LLC, Wheaten LLC
-
dba Signature Healthcare of Carrollton Rehab & Wellness Center
- Skilled Nursing Facility
- Carrollton, KY
- NPI 1134599525
Jjla LLC, Wheaten LLC
-
dba Signature Healthcare at Summit Manor Rehab & Wellness Center
- Skilled Nursing Facility
- Columbia, KY
- NPI 1255701397
Jjla LLC, Wheaten LLC
-
dba Danville Centre for Health & Rehabilitation
- Skilled Nursing Facility
- Danville, KY
- NPI 1992129613
Jjla LLC, Wheaten LLC
-
dba Signature HealthCARE of Elizabethtown
- Skilled Nursing Facility
- Elizabethtown, KY
- NPI 1922422690
Jjla LLC, Signature Healthcare LLC, Wheaten LLC
Practitioners & affiliated clinicians
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.
-
- Internal Medicine Physician
- Louisville, KY
- NPI 1891749305
Affiliated clinicians 1
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": "1186272000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1680566400000",
"number": "1891986170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12201 BLUEGRASS PKWY",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402992361",
"telephone_number": "502-568-7800",
"fax_number": "502-568-7150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 CRISTLAND RD",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402144150",
"telephone_number": "502-367-0104",
"fax_number": "502-368-5208"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LP LOUISVILLE SOUTH LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "LP CR HOLDINGS LLC",
"enumeration_date": "2007-08-05",
"last_updated": "2023-04-04",
"certification_date": "2023-04-04",
"status": "A",
"authorized_official_last_name": "HARRISON",
"authorized_official_first_name": "JOHN",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "502-568-7800",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "KY",
"license": "100452",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Signature HealthCARE of South Louisville",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Signature HealthCARE of South Louisville",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Louisville, KY
- LP Louisville Herr Lane, LLC (Signature Healthcare at Jefferson Place Rehab & Wellness Center)
- LP Louisville Hospital South, LLC (Signature Healthcare at U of L Mary & Elizabeth Hospital)
- LP Louisville Lynn Way, LLC (Signature Healthcare at Jefferson Manor Rehab & Wellness Center)
- LP Louisville Northfield LLC (Signature HealthCARE at Glenview)
- LP Louisville Quinn Drive, LLC (Signature Healthcare at Rockford Rehab & Wellness Center)
- LP Louisville Whipps Mill Road, LLC (Signature Healthcare at Meadowview Rehab & Wellness Center)
- LP Madison, LLC (Signature HealthCARE of Madison)
- LP Memphis IV, LLC (Signature HealthCARE at Methodist)
- LSC Physical Therapy, PSC
- Pobe Luangjarmekorn, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2023; 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.