Active NPI
HBNC, Inc.
Doing business as Southridge Village Nursing and Rehab
- Skilled Nursing Facility
- Heber Springs, AR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 1042
- Legal business name
- HBNC, INC.
- Doing business as
- Southridge Village Nursing and Rehab
- Practice address
- 400 Southridge Pkwy
Heber Springs, AR 72543-8855 - Phone
- (501) 362-3185
- Fax
- (501) 362-2519
- NPI assigned
- Mar 6, 2014
- Last updated
- Nov 12, 2014
- Organization subpart
- Yes
- Parent organization
- EAGLE HEALTH SYSTEMS, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Brandon Adams
- Title
- President
- Phone
- (501) 932-0050
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 1042 | AR | Primary |
Addresses
Primary practice location
400 Southridge Pkwy
Heber Springs, AR 72543-8855
Mailing address
400 Southridge Pkwy
Heber Springs, AR 72543-8855
Phone (501) 362-3185
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 202100311 | Medicaid | AR |
Other names 1
- SOUTHRIDGE VILLAGE NURSING AND REHAB
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140730000194 | AR | Part A Provider - Skilled Nursing Facility | 5698991560 | Practice locations: Herber Springs, AR |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1982020541. Details of each certification follow.
Skilled nursing facility certification: CCN 045196
- Legal name
- HBNC, INC.
- Doing business as
- SOUTHRIDGE VILLAGE NURSING AND REHAB
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Apr 1, 1992
- Last certification
- Jul 25, 2024
- Beds
- 122
- Ownership / control type
- Corporation
- Multi-facility organization
- Reliance Healthcare DBA Southridge Village
- Organization structure
- Corporation
- Incorporated
- Dec 3, 2013 in AR
- Enrollment address
- Southeridge Village Nursing and Rehab
400 Southridge Parkway
Herber Springs, AR 72543-8855 - Nursing home name
- SOUTHRIDGE VILLAGE NURSING AND REHAB
- Affiliated entity
- ANTHONY & BRYAN ADAMS
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Southridge Village Nursing and Rehab
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Apr 1, 1992
- Medicare certification status
- Active
- Certified beds
- 122
- Chain
- Anthony & Bryan Adams
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 |
|---|---|---|---|
| 04D1030130 | Southridge Village Nursing and Rehab | Certificate of waiver | Aug 30, 2026 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 20
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 |
|---|---|---|---|
| Shana Rodgers | Operational/Managerial Control | Jul 1, 2022 | 100% |
| Managing Control - Governing Body | Jul 1, 2022 | ||
| Adp of the SNF | Jul 1, 2022 | ||
| Benjamin Cooper | Adp of the SNF | Jan 1, 2020 | |
| Bryan Milburn Adams | 5% Or Greater Indirect Ownership Interest | Apr 1, 2014 | 50% |
| Corporate Officer | Apr 1, 2014 | 50% | |
| Franklin Gale Bivins | Operational/Managerial Control | Aug 28, 2024 | |
| Adp of the SNF | Aug 28, 2024 | ||
| Eagle Health Systems Inc | 5% Or Greater Direct Ownership Interest | Apr 1, 2014 | 100% |
| Nacole Jack | Managing Control - Governing Body | Aug 28, 2024 | |
| Adp of the SNF | Aug 28, 2024 | ||
| James B Cooper | Adp of the SNF | Jan 1, 2020 | |
| LTC Systems/RX, LLC | Adp of the SNF | Apr 1, 2014 | |
| Larry M McGinnis | Adp of the SNF | Apr 1, 2014 | |
| Pharmacy Consults, LLC | Adp of the SNF | Apr 1, 2014 | |
| Incite Rehab, LLC | Adp of the SNF | Apr 1, 2014 | |
| Health Care Solutions, LLC | Adp of the SNF | Apr 1, 2019 | |
| Rita Pedigo | Adp of the SNF | Apr 1, 2014 | |
| William Mainord | Adp of the SNF | Apr 1, 2014 | |
| John Ellis | Corporate Officer | Apr 1, 2014 | |
| Adp of the SNF | Apr 1, 2014 | ||
| Reliance Health Care, Inc. | Adp of the SNF | Apr 1, 2014 | |
| Robert Cooper | Adp of the SNF | Jan 1, 2020 | |
| Tobey Koehler | Corporate Officer | Apr 1, 2014 | |
| Adp of the SNF | Apr 1, 2014 | ||
| Anthony Brandon Adams | 5% Or Greater Indirect Ownership Interest | Apr 1, 2014 | 50% |
| Corporate Officer | Apr 1, 2014 | 50% | |
| Darryl Thomas | Managing Control - Governing Body | Apr 1, 2014 | |
| Adp of the SNF | Apr 1, 2014 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Medicine Physician
- Heber Springs, AR
- NPI 1427038082
Adp of the SNF, Operational/Managerial Control
Facilities with the same owner 9
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Eaglecrest Nursing and Rehab
- Skilled Nursing Facility
- Ash Flat, AR
- NPI 1487070058
Eagle Health Systems Inc
-
dba Corning Therapy and Living Center
- Skilled Nursing Facility
- Corning, AR
- NPI 1114354990
Eagle Health Systems Inc
-
dba Twin Lakes Therapy and Living
- Skilled Nursing Facility
- Flippin, AR
- NPI 1043636699
Eagle Health Systems Inc
-
dba Gassville Therapy and Living
- Skilled Nursing Facility
- Gassville, AR
- NPI 1528484177
Eagle Health Systems Inc
-
dba Care Manor Nursing and Rehab
- Skilled Nursing Facility
- Mountain Home, AR
- NPI 1376969931
Eagle Health Systems Inc
-
dba Hiram Shaddox Health and Rehab
- Skilled Nursing Facility
- Mountain Home, AR
- NPI 1225454325
Eagle Health Systems Inc
-
dba Pioneer Therapy and Living
- Skilled Nursing Facility
- Melbourne, AR
- NPI 1952727521
Eagle Health Systems Inc
-
dba Rector Nursing and Rehab
- Skilled Nursing Facility
- Rector, AR
- NPI 1841627627
Eagle Health Systems Inc
-
dba Southfork River Therapy and Living
- Skilled Nursing Facility
- Salem, AR
- NPI 1285059261
Eagle Health Systems Inc
Practitioners & affiliated clinicians
Affiliated clinicians 3
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Family Medicine Physician
- Heber Springs, AR
- NPI 1972582534
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1394064000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1415750400000",
"number": "1982020541",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 SOUTHRIDGE PKWY",
"city": "HEBER SPRINGS",
"state": "AR",
"postal_code": "725438855",
"telephone_number": "501-362-3185",
"fax_number": "501-362-2519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 SOUTHRIDGE PKWY",
"city": "HEBER SPRINGS",
"state": "AR",
"postal_code": "725438855",
"telephone_number": "501-362-3185",
"fax_number": "501-362-2519"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HBNC, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "EAGLE HEALTH SYSTEMS, INC.",
"enumeration_date": "2014-03-06",
"last_updated": "2014-11-12",
"status": "A",
"authorized_official_last_name": "ADAMS",
"authorized_official_first_name": "BRANDON",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "501-932-0050"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "AR",
"license": "1042",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "202100311",
"state": "AR"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "SOUTHRIDGE VILLAGE NURSING AND REHAB",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Heber Springs, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2014; 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.