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SHADY LAWN NURSING HOME
NPI 1255405700
Skilled Nursing Facility in Cadiz, KY

Active since November 17, 2006CLIA 18D0648656 · Waiver
2582 CERULEAN RD, CADIZ, KY 42211(270) 522-3236(270) 522-0825 Get Directions Write a Review

NPPES record last updated: April 1, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Shady Lawn Nursing Home NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHADY LAWN NURSING HOME (NPI 1255405700) is a healthcare organization registered as a skilled nursing facility in Cadiz, Kentucky and active in the NPI registry since November 2006. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Donna Jo Maassen, Director Of Compliance, as its authorized official.

NPPES Registry Identity

NPI1255405700
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameEXTENDICARE HOMES, INC.
Location Address2582 CERULEAN RDCadiz, KY 42211-9605
Mailing Address111 W Michigan StMilwaukee, WI 53203-2903 · (414) 908-8119 · Fax (414) 908-7105
Phone(270) 522-3236
Fax(270) 522-0825
Organization SubpartNo
Authorized OfficialDonna Jo MaassenDirector Of Compliance · (414) 908-8119
Enumeration DateNovember 17, 2006
Last NPPES UpdateApril 1, 2008
✔ NPI 1255405700 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
2582 CERULEAN RD, Cadiz, KY 42211
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Other Names 1

Doing Business AsShady Lawn Nursing Home

Other Identifiers 2

Medicaid12501110KY
Medicare OSCAR/certification185252KY

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 18D0648656

Shady Lawn Opco LLC D/B/A Shady Lawn Nursing And Rehabilitation Center · Cadiz, KY
Active · expires Aug 31, 2026
CLIA Number18D0648656
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorMs. Dana J. Radford
Laboratory Phone(270) 522-3236
Laboratory LocationShady Lawn Opco LLC D/B/A Shady Lawn Nursing And Rehabilitation Center2582 Cerulean Rd, Cadiz, KY 42211
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. BARRY WALKER PTA
Physical Therapy Assistant
2582 CERULEAN RD
CADIZ, KY 42211
Trigg County (270) 522-3236
REBECCA CRAVENS FNP-BC
Nurse Practitioner (Family)
2582 CERULEAN RD
CADIZ, KY 42211
Trigg County (731) 394-1145
MS. KELLY CLOERN PTA
Physical Therapy Assistant
2582 CERULEAN RD
CADIZ, KY 42211
Trigg County (207) 522-3236
MRS. CRISANN LEIGH CHANDLER SLP-CCC
Speech-Language Pathologist
2582 CERULEAN RD
CADIZ, KY 42211
Trigg County (270) 522-3236
MRS. MARSHA DAWN SPAIN OTR/L
Occupational Therapist
2582 CERULEAN RD
CADIZ, KY 42211
Trigg County (270) 522-3236
CHRYSTAL ROGERS APRN
Nurse Practitioner (Primary Care)
2582 CERULEAN RD
CADIZ, KY 42211
Trigg County (731) 394-1145
DAWN MICHELE VILLINES
Physical Therapy Assistant
2582 CERULEAN RD
CADIZ, KY 42211
Trigg County (270) 522-3236
BIANCA HOOD
Nurse Practitioner
2582 CERULEAN RD
CADIZ, KY 42211
Trigg County (731) 394-1145

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Extendicare Homes, Inc.'s NPI number?

The NPI number for Extendicare Homes, Inc. is 1255405700. It was assigned to this organization in the NPPES registry on November 17, 2006. The provider is doing business as Shady Lawn Nursing Home.

Where is Extendicare Homes, Inc. located?

Extendicare Homes, Inc. is located at 2582 Cerulean Rd, Cadiz, KY 42211. The listed phone number is (270) 522-3236.

What is Extendicare Homes, Inc.'s specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Extendicare Homes, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 18D0648656) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Extendicare Homes, Inc. was last updated on April 1, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.