Christian Care Center of Bolivar LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CHRISTIAN CARE CENTER OF BOLIVAR LLC

Practice address

10160 Highway 64W
Bolivar, TN 38008

Phone

(423) 975-5455

Fax

(423) 390-0743

NPI assigned

Mar 31, 2021

Organization subpart

No

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

Authorized official

Name

Ms. Lisa M Cawood Gray

Title

Delegated Official, Registrations O

Phone

(423) 557-6116

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Skilled nursing facility certification: CCN 445537

Legal name

CHRISTIAN CARE CENTER OF BOLIVAR LLC

Doing business as

CHRISTIAN CARE CENTER OF BOLIVAR

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Oct 12, 2021

Last certification

Apr 9, 2025

Beds

67

Ownership / control type

Individual

Most recent change of ownership

Sep 1, 2025

Organization structure

LLCProprietary

Incorporated

Jul 6, 2017 in TN

Enrollment address

10160 Highway 64W
Bolivar, TN 38008-3577

Listed as

Bolivar Health & Rehabilitation LLCCCN 445537

Overall star rating

5 of 5

Health inspections

5 of 5

Staffing

2 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Oct 12, 2021

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

6756.4 residents per day on average

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 6

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

Facilities with the same owner 5

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

• Abundant Christian Living Community LLC

  • Skilled Nursing Facility
  • Johnson City, TN
  • NPI 1902491178

  Care Centers Management Consulting, Inc.

  CMS ownership
• Christian Care Center of Milan, LLC

  • Nursing Facility/Intermediate Care Facility
  • Medina, TN
  • NPI 1619629250

  Care Centers Management Consulting, Inc.

  CMS ownership
• Christian Care Center of Unicoi County LLC

  • Skilled Nursing Facility
  • Erwin, TN
  • NPI 1477037497

  Care Centers Management Consulting, Inc.

  CMS ownership
• Ivy Hall, Inc

  • Skilled Nursing Facility
  • Elizabethton, TN
  • NPI 1851362511

  Care Centers Management Consulting, Inc.

  CMS ownership
• KDM Inc

  • Skilled Nursing Facility
  • Chuckey, TN
  • NPI 1124080221

  Care Centers Management Consulting, Inc.

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elbert Edwin Hines III, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • Memphis, TN
  • NPI 1801896881
  NPD (past)

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

{
    "created_epoch": "1617148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643587200000",
    "number": "1972181998",
    "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": "10160 HIGHWAY 64W",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "38008",
            "telephone_number": "423-975-5455",
            "fax_number": "423-390-0743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTIAN CARE CENTER OF BOLIVAR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-31",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A",
        "authorized_official_last_name": "CAWOOD GRAY",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DELEGATED OFFICIAL, REGISTRATIONS O",
        "authorized_official_telephone_number": "423-557-6116",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Carter, PHARM D.
• Thomas J Caruthers Jr., MD
• Randall Wayne Castellaw
• Vijaya K Chandel, M.D.
• Satoria Cheairs, BS
• Clark Family Clinic, LLC
• Peggy Clark, LMSW
• Candice Mignonne Cook, M.ED
• Lindsey Hendrix Cook, APRN
• Cornerstone Health Care of Bolivar, Inc.

• All providers in Bolivar, TN
• Skilled Nursing Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; 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.