PROVIDENCE PARK REHABILITATION AND SKILLED NURSING
NPI 1508254046
Skilled Nursing Facility in Tyler, TX

Q: What is Hopkins County Hospital District's NPI number?

The NPI number for Hopkins County Hospital District is 1508254046. It was assigned to this organization in the NPPES registry on January 7, 2015. The provider is doing business as Providence Park Rehabilitation And Skilled Nursing.

Q: What is Hopkins County Hospital District's specialty?

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

Active since January 07, 2015CLIA 45D2029733 · Waiver

2/5

Overall Rating

5505 NEW COPELAND RD, TYLER, TX 75703(903) 939-2443(903) 939-2479 Get Directions Write a Review

NPPES record last updated: January 7, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Providence Park Rehabilitation And Skilled Nursing NPPES

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

PROVIDENCE PARK REHABILITATION AND SKILLED NURSING (NPI 1508254046) is a healthcare organization registered as a skilled nursing facility in Tyler, Texas and active in the NPI registry since January 2015. The organization holds a CLIA Waiver certificate valid through September 13, 2027 and lists Michael Mcandrew, Ceo, as its authorized official.

NPPES Registry Identity

NPI1508254046

Entity TypeOrganization

Primary Taxonomy314000000X

Legal Business NameHOPKINS COUNTY HOSPITAL DISTRICT

Location Address5505 NEW COPELAND RDTyler, TX 75703-3955

Mailing Address115 Airport RdSulphur Springs, TX 75482-2105 · (903) 439-4952

Phone(903) 939-2443

Fax(903) 939-2479

Organization SubpartNo

Authorized OfficialMichael McandrewCeo · (903) 439-4952

Enumeration DateJanuary 7, 2015

✔ NPI 1508254046 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.

5505 NEW COPELAND RD, Tyler, TX 75703

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Other Names 1

Doing Business AsProvidence Park Rehabilitation And Skilled Nursing

Other Identifiers 1

Medicare OSCAR/certification676184TX

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 45D2029733

Providence Park Rehabilitation And Skilled Nursing · Tyler, TX

Active · expires Sep 13, 2027

CLIA Number45D2029733

Laboratory TypeSkilled Nursing Facility/Nursing Facility

Certificate Effective DateSeptember 14, 2025

Certificate Expiration DateSeptember 13, 2027

Laboratory DirectorJohn Mckeehan

Laboratory Phone(903) 939-2443

Laboratory LocationProvidence Park Rehabilitation And Skilled Nursing5505 New Copeland Rd, Tyler, TX 75703

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Nursing Home Quality Ratings CMS Care Compare

Quality ratings, staffing and inspection history for Providence Park Rehabilitation And Skilled Nursing (CMS certification number 676184), from CMS Care Compare.

Providence Park Rehabilitation And Skilled Nursing

Nursing home · Tyler, TX

2/5 CMS Overall Rating

OwnershipFor profit - Limited Liability company

CMS Certification Number676184

Certified Beds125 beds99 residents per day on average

Medicare & Medicaid Participant SinceJuly 24, 2008

Resident & Family CouncilResident and family councils

Automatic sprinkler system

CMS Star Ratings

Quality Measures

Based on a select set of clinical quality measures.

3/5

Long-Stay Quality

Quality of care delivered to long-term residents.

3/5

Short-Stay Quality

Quality of care delivered to short-term and rehabilitation residents.

3/5

Staffing

Based on nursing staff hours relative to resident needs.

2/5

Weighted Health Inspection Score

Lower scores are better; the score summarizes deficiencies found on recent inspections.

90.67

Ratings are assigned by CMS on a one-to-five star scale; five is the highest. Categories without a current CMS rating are not shown.

Staffing & Turnover

Total Nurse Staffing

nurse aide 2.05 · LPN 0.8 · RN 0.5

3.34 hrs per resident per day

Weekend Nurse Staffing

2.92 hrs per resident per day

Physical Therapist Staffing

0.03 hrs per resident per day

Nursing Staff Turnover

Share of nursing staff who left the facility within the past year.

69.4%

Registered Nurse Turnover

46.7%

Administrators Who Have Left

In the past year.

Higher staffing hours generally allow more direct care time per resident.

Inspections & Enforcement

Facility-Reported Incidents

Substantiated Complaints

Infection-Control Citations

Fines

1 totaling $14,521.00

Medicare Payment Denials

Total Penalties

Counts come from CMS inspections and complaint investigations over approximately the past three years. CMS Care Compare data as of October 1, 2024.

Other Providers at the Same Location NPPES 19

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

LAYNE HEALTHCARE, PLLC

Skilled Nursing Facility