NPIMap

Organization Active NPI

Abundant Christian Living Community LLC

  • Skilled Nursing Facility
  • Johnson City, TN
National Provider Identifier
1902491178
Registry record updated Mar 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
ABUNDANT CHRISTIAN LIVING COMMUNITY LLC
Practice address
2012 Sherwood Dr
Johnson City, TN 37601-3238
Phone
(423) 232-8200
Fax
(423) 232-8240
NPI assigned
Mar 9, 2021
Last updated
Mar 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2021

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

Authorized official

Name
Mr. Jimmy R. LewisNPI 1730831363
Title
Chief Manager
Phone
(423) 975-5455

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X NU
Nursing Facility/Intermediate Care Facility 313M00000X NU
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

2012 Sherwood Dr
Johnson City, TN 37601-3238

Mailing address

2020 Northpark Dr Ste 2D
Johnson City, TN 37604-3127
Phone (423) 975-5455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211109000454 TN Part A Provider - Skilled Nursing Facility 9234528506 Practice locations: Johnson City, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902491178. Details of each certification follow.

Skilled nursing facility certification: CCN 445483

Legal name
ABUNDANT CHRISTIAN LIVING COMMUNITY LLC
Doing business as
ABUNDANT CHRISTIAN LIVING COMMUNITY REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 2007
Last certification
Jul 9, 2024
Beds
103
Ownership / control type
Corporation
Organization structure
LLCProprietary
Enrollment address
2012 Sherwood Dr
Johnson City, TN 37601-3238
Nursing home name
ABUNDANT CHRISTIAN LIVING COMMUNITY REHABILITATION

Care Compare: Nursing home

Medicare Care Compare
Listed as
Abundant Christian Living Community RehabilitationCCN 445483 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jan 1, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10392.0 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D0310573Abundant Christian Living Community, LLC2012 Sherwood Drive, Johnson City, TN 37601Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 25

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

NameRoleSinceShare
Tuesday Jones Individual Adp of the SNF Apr 23, 2025
Tayzere I Arnott Individual Operational/Managerial Control Apr 28, 2026
Managing Control - Governing BodyBusiness Office Manager Apr 28, 2026
Adp of the SNF Apr 28, 2026
Encore Healthcare, LLC Organization, Livingston, TN LLC, Medical provider/supplier Adp of the SNF Aug 1, 2023
The First Bank and Trust Company Organization, Johnson City, TN Corporation, Financial institution 5% Or Greater Mortgage Interest Jun 16, 2021 4.25%
Adp of the SNF Jun 19, 2021
State of Franklin Healthcare Associates, PLLC Organization, Johnson City, TN LLC, Medical provider/supplier, Consulting firm Adp of the SNF Jan 1, 2026
Lisa Cawood-Gray Individual Corporate Officer Nov 25, 2019
Operational/Managerial Control Nov 25, 2019
Managing Control - Governing BodyRegistrations & Certification Nov 25, 2019
Adp of the SNF Nov 25, 2019
United RX LLC Organization, Johnson City, TN LLC, Consulting firm Adp of the SNF Jan 1, 2022
Claxton Dietetic Solutions, LLC Organization, Knowville, TN LLC, Consulting firm Adp of the SNF Jun 19, 2021
Jimmy R Lewis Individual 5% Or Greater Direct Ownership InterestChief Manager Jun 19, 2021
Corporate OfficerChief Manager and President Nov 25, 2019
Corporate DirectorChief Manager Jun 19, 2021
Operational/Managerial Control Nov 25, 2019
Adp of the SNF Nov 25, 2019
Broad River Rehabilitation Organization, Arden, NC LLC, Medical provider/supplier, Management services company Operational/Managerial Control Jun 19, 2021
Adp of the SNF Jun 19, 2021
Anita B West Individual Corporate OfficerSecretary Treasurer Jan 1, 2009
Operational/Managerial ControlSecretary Treasurer Nov 25, 2019
Adp of the SNF Nov 25, 2019
Sherry a Starnes Individual Operational/Managerial Control Nov 13, 2023
Managing Control - Governing BodyDirector of Nursing Nov 13, 2023
Adp of the SNF Nov 13, 2023
Blackburn, Childers & Steagall PLC Organization, Johnson City, TN LLC Adp of the SNF Jun 19, 2021
Care Centers Management Consulting, Inc. Organization, Johnson City, TN Corporation, Management services company, Consulting firm, For-profit Operational/Managerial Control Nov 25, 2019
Adp of the SNF Nov 25, 2019
Tami Greenlee Individual Operational/Managerial Control Sep 30, 2025
Managing Control - Governing BodyDietary Director Sep 30, 2025
Adp of the SNF Sep 30, 2025
Dena Sparkman Individual Operational/Managerial Control Dec 1, 2025
Managing Control - Governing BodyAdministrator, Executive Directo Dec 1, 2025
Adp of the SNF Dec 1, 2025
CCRC Real Estate Investors LLC Organization, Johnson City, TN Created for acquisition, LLC, Owned by another organization or individual 5% Or Greater Mortgage Interest Jun 19, 2021 5%
Joy Powers Individual Operational/Managerial Control Sep 30, 2025
Managing Control - Governing BodyInterim Adminstrator Sep 30, 2025
Adp of the SNF May 11, 2026
Alyssa Meadows Individual Adp of the SNF Nov 9, 2025
Amy Lawrence Individual Adp of the SNF Jan 1, 2026
Edward Triplett Individual Operational/Managerial Control Jul 12, 2021
Managing Control - Governing BodyAssistant Director of Nursing Jul 12, 2021
Adp of the SNF Jul 12, 2021
Inpatient Consultants of Tennessee PC Organization, Knoxville, TN Corporation, Medical provider/supplier 5% Or Greater Direct Ownership Interest Jun 8, 2004 100%
Adp of the SNF Jun 19, 2021
Brooke Kemper Individual Managing Control - Governing BodyActivities Director Feb 9, 2026
Adp of the SNF Feb 9, 2026
Shiftkey LLC Organization, Irving, TX LLC, Medical staffing company Adp of the SNF Jul 7, 2026
Julie Marie Reddick Individual Adp of the SNF Jan 1, 2026

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 4

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.

Affiliated clinicians 3

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": "1615248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615334400000",
    "number": "1902491178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 NORTHPARK DR STE 2D",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376043127",
            "telephone_number": "423-975-5455",
            "fax_number": "423-390-0743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2012 SHERWOOD DR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376013238",
            "telephone_number": "423-232-8200",
            "fax_number": "423-232-8240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABUNDANT CHRISTIAN LIVING COMMUNITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-09",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "CHIEF MANAGER",
        "authorized_official_telephone_number": "423-975-5455",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.