Signature Healthcare of Elizabethon Rehab & Wellne
1200 Spruce Lane, Elizabethton, TN 37643


Signature Healthcare of Elizabethon Rehab & Wellne is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 445217. The address is 1200 Spruce Lane, Elizabethton, TN 37643. The zip code is 37643. The phone number is 4235433202.


Signature Healthcare of Elizabethon Rehab & Wellne · 1200 Spruce Lane, Elizabethton, TN 37643

Federal Provider Number 445217
Provider Name SIGNATURE HEALTHCARE OF ELIZABETHON REHAB & WELLNE
Address 1200 SPRUCE LANE
ELIZABETHTON, TN 37643
Phone Number 4235433202
SSA County Code 90
County Name Carter
Ownership Type For profit - Corporation
Certified Beds 94
Certified Beds Residents 73
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name LP ELIZABETHTON LLC
Date First Approved to Provide Medicare Medicaid Services 02/17/1989
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Both
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 3
Health Inspection Rating 3
Quality Measure Rating 3
Staffing Rating 3
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 1.87671
Reported LPN Staffing Hours per Resident per Day 0.80205
Reported RN Staffing Hours per Resident per Day 0.85685
Reported Licensed Staffing Hours per Resident per Day 1.6589
Reported Total Nurse Staffing Hours per Resident per Day 3.53561
Reported Physical Therapist Staffing Hours per Resident Per Day 0.16438
Expected CNA Staffing Hours per Resident per Day 2.564
Expected LPN Staffing Hours per Resident per Day 0.6501
Expected RN Staffing Hours per Resident per Day 1.14027
Expected Total Nurse Staffing Hours per Resident per Day 4.35437
Adjusted CNA Staffing Hours per Resident per Day 1.79597
Adjusted LPN Staffing Hours per Resident per Day 1.02401
Adjusted RN Staffing Hours per Resident per Day 0.56148
Adjusted Total Nurse Staffing Hours per Resident per Day 3.27296
Cycle 1 Total Number of Health Deficiencies 2
Cycle 1 Number of Standard Health Deficiencies 2
Cycle 1 Health Deficiency Score 32
Cycle 1 Standard Survey Health Date 11/16/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 32
Cycle 2 Standard Health Survey Date 11/10/2015
Cycle 3 Total Number of Health Deficiencies 2
Cycle 3 Number of Standard Health Deficiencies 2
Cycle 3 Health Deficiency Score 8
Cycle 3 Standard Health Survey Date 09/24/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 8
Total Weighted Health Survey Score 17.333
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Signature Healthcare of Elizabethon Rehab & Wellne

Owner Name Role Association Date
ADAMS, SANDRA (Individual) OFFICER since 11/01/2007
ASCHENBECK, JAMES (Individual) OPERATIONAL/MANAGERIAL CONTROL since 08/28/2014
CUTLER, DEANNE (Individual) OPERATIONAL/MANAGERIAL CONTROL since 07/21/2014
HARRISON, JOHN (Individual) OFFICER since 11/01/2007
JJLA LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/01/2007
LP CR HOLDINGS LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 11/01/2007
LPSNF II, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 10/01/2016
SIGNATURE HEALTHCARE CLINICAL CONSULTING SERVICES LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 11/01/2007
SIGNATURE HEALTHCARE CONSULTING SERVICES LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 11/01/2007
SIGNATURE HOLDINGS II, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 10/01/2016
SMEDRA, IRA (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/01/2007
STEIER, E (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/01/2007
STREET, DEBBIE (Individual) OPERATIONAL/MANAGERIAL CONTROL since 11/01/2007
WHEATEN LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/01/2007
WINTNER, JACOB (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/01/2007

37643 · Nursing Home

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