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Largest nursing-home companies in the US — and where the money goes

Insights

Most nursing homes belong to a chain, and the chain — not the single building — often sets staffing budgets and where the money goes. A whole portfolio that rates below average, or one moving large sums to related companies, is a pattern worth researching that no single facility page reveals.

We roll every CMS nursing-home record up to the operator level. 590 chains of 3 or more homes are profiled here, covering 10,076 homes. Each chain page shows its average rating, how many of its homes carry immediate-jeopardy or Special Focus flags, aggregate finances including related-party payments, and every home it runs.

Why this matters. Consumer directories stop at the single building. But research into nursing-home quality keeps coming back to who owns the operator — especially private-equity and REIT chains that can route money to affiliated landlords and management companies. CMS under-reports those ties, so treat every count here as a floor.

Largest chains

The operators running the most homes, by facility count. Size isn’t good or bad on its own — it’s the reach of any pattern, good or bad, across the portfolio.

#ChainHomesBedsStatesAvg CMS ratingFlagsRevenueRelated-party $% of opexOperating margin
1THE ENSIGN GROUP34237,336173.2★91 IJ (27%) · 33 abuse (10%)$4.2B$404.1M0%+7.2%
2PACS GROUP27431,164162.9★68 IJ (25%) · 2 SFF (1%) · 28 abuse (10%)$3.9B$273.0M0%+5.3%
3LIFE CARE CENTERS OF AMERICA19425,340263.4★26 IJ (13%) · 15 abuse (8%)$2.2B$439.5M0%-1.3%
4GENESIS HEALTHCARE18421,582182.4★69 IJ (38%) · 4 SFF (2%) · 27 abuse (15%)$2.5B$388.8M0%+1.0%
5CREATIVE SOLUTIONS IN HEALTHCARE14917,67012.1★77 IJ (52%) · 22 abuse (15%)$822.3M$9.7M0%-12.3%
6SABER HEALTHCARE GROUP12613,56862.9★27 IJ (21%) · 12 abuse (10%)$1.3B$180.8M0%+2.3%
7TRILOGY HEALTH SERVICES PE 4/1231238,02454.2★4 IJ (3%)$1.3B$167.7M0%+3.9%
8AVIR HEALTH GROUP REIT 1/11611612,69612.3★72 IJ (62%) · 19 abuse (16%)$659.2M$7.3M0%+3.3%
9COMMUNICARE HEALTH11011,95453.2★37 IJ (34%) · 13 abuse (12%)$1.3B$221.8M0%+3.0%
10PRUITTHEALTH9510,42342.9★23 IJ (24%) · 2 abuse (2%)$900.7M$217.4M0%-4.5%
11GOOD SAMARITAN SOCIETY925,88393.0★18 IJ (20%) · 1 SFF (1%) · 6 abuse (7%)$639.7M$103.9M0%-6.0%
12AMERICAN SENIOR COMMUNITIES908,94813.9★2 IJ (2%) · 4 abuse (4%)$801.7M$112.2M0%-2.6%
13LEGACY HEALTHCARE REIT 1/898910,87932.9★19 IJ (21%) · 1 SFF (1%) · 12 abuse (13%)$978.4M$105.8M0%-4.1%
14MARQUIS HEALTH SERVICES8712,02393.0★22 IJ (25%) · 7 abuse (8%)$1.4B$210.5M0%-1.3%
15COMPLETE CARE8512,08183.1★32 IJ (38%) · 6 abuse (7%)$1.2B$145.5M0%-3.0%
16CIENA HEALTHCARE/LAUREL HEALTH CARE819,35042.8★12 IJ (15%) · 9 abuse (11%)$996.5M$136.2M0%-4.6%
17SIMCHA HYMAN & NAFTALI ZANZIPER797,98562.6★26 IJ (33%) · 5 abuse (6%)$747.4M$174.2M0%+3.0%
18INFINITY HEALTHCARE CONSULTING698,65632.0★17 IJ (25%) · 1 SFF (1%) · 16 abuse (23%)$616.2M$89.5M0%-2.3%
19NATIONAL HEALTHCARE CORPORATION698,59984.0★11 IJ (16%) · 3 abuse (4%)$875.6M$72.6M0%-1.6%
20SIGNATURE HEALTHCARE REIT 1/67677,58653.1★14 IJ (21%) · 3 abuse (4%)$677.0M$86.6M0%-4.4%
21WELLSENTIAL HEALTH678,69512.7★29 IJ (43%) · 8 abuse (12%)$533.6M$1.0M0%-7.4%
22FUNDAMENTAL HEALTHCARE667,90562.4★29 IJ (44%) · 1 SFF (2%) · 6 abuse (9%)$572.7M$31.4M0%-4.8%
23OPCO SKILLED MANAGEMENT667,94742.3★36 IJ (55%) · 17 abuse (26%)$566.2M$85.9M0%-7.9%
24FOUNDATIONS HEALTH SOLUTIONS646,16114.1★6 IJ (9%)$634.8M$68.4M0%+7.6%
25LIFEWORKS REHAB648,71652.1★26 IJ (41%) · 3 SFF (5%) · 11 abuse (17%)$1.1B$156.4M0%+4.3%
26AUTUMN LAKE HEALTHCARE598,00552.8★11 IJ (19%) · 5 abuse (8%)$949.6M$151.4M0%+0.2%
27NORTH SHORE HEALTHCARE593,88842.7★23 IJ (39%) · 2 abuse (3%)$323.2M$16.6M0%+3.3%
28JAMES & JUDY LINCOLN565,54522.4★12 IJ (21%) · 2 SFF (4%) · 8 abuse (14%)$251.2M$75.3M0%-13.2%
29MEDILODGE535,65213.1★9 IJ (17%) · 8 abuse (15%)$518.8M$77.1M0%-4.4%
30NEXION HEALTH515,38632.2★20 IJ (39%) · 1 SFF (2%) · 5 abuse (10%)$391.1M$16.7M0%-0.6%
31AVIATA HEALTH GROUP506,04512.4★16 IJ (32%) · 8 abuse (16%)$236.1M$18.5M0%-18.0%
32ETHICA HEALTH504,82213.6★6 IJ (12%) · 3 abuse (6%)$358.7M$78.7M0%-6.1%
33BENJAMIN LANDA486,35243.4★9 IJ (19%) · 2 abuse (4%)$727.7M$109.7M0%-6.0%
34DAVID JOHNSON485,21023.2★10 IJ (21%) · 6 abuse (12%)$718.1M$61.0M0%-0.9%
35THE BEEBE FAMILY484,93122.8★8 IJ (17%) · 2 abuse (4%)$443.0M$40.6M0%+3.9%
36CASCADIA HEALTHCARE463,74253.0★7 IJ (15%) · 1 SFF (2%) · 2 abuse (4%)$372.3M$25.8M0%+1.1%
37MONARCH HEALTHCARE MANAGEMENT453,43912.2★14 IJ (31%) · 6 abuse (13%)$366.0M$45.1M0%+0.2%
38DIVERSICARE HEALTHCARE444,74452.6★11 IJ (25%) · 1 abuse (2%)$378.6M$30.7M0%+5.5%
39EVERGREEN HEALTHCARE GROUP REIT 2/44444,22262.5★9 IJ (20%) · 1 SFF (2%) · 10 abuse (23%)$280.7M$11.0M0%-4.7%
40CARE INITIATIVES432,76412.9★11 IJ (26%) · 1 abuse (2%)$236.7M$21.7M0%+4.2%
41HILL VALLEY HEALTHCARE435,45261.8★15 IJ (35%) · 7 abuse (16%)$557.2M$56.6M0%-1.5%
42LIFE CARE SERVICES REIT 1/43432,901184.1★6 IJ (14%)$705.3M$10.0M0%-22.8%
43NHS MANAGEMENT435,53032.9★5 IJ (12%) · 2 abuse (5%)$522.2M$196.1M0%-0.5%
44SOVEREIGN HEALTHCARE HOLDINGS435,40733.7★7 IJ (16%) · 3 abuse (7%)$567.8M$32.2M0%+2.8%
45NATIONAL HEALTH CARE ASSOCIATES425,50663.2★6 IJ (14%) · 8 abuse (19%)$733.4M$160.5M0%-3.9%
46ACCURA HEALTHCARE412,14142.5★12 IJ (29%) · 2 abuse (5%)$180.8M$8.7M0%-5.2%
47CORPORATE INTERFACE SERVICES403,84412.5★9 IJ (22%) · 6 abuse (15%)$405.3M$38.8M0%-5.8%
48PRINCIPLE LONG TERM CARE405,23833.0★5 IJ (12%) · 4 abuse (10%)$448.0M$100.2M0%-0.5%
49ANTHONY & BRYAN ADAMS384,10123.8★4 IJ (11%)$335.6M$64.4M0%+9.1%
50ASTON HEALTH385,02312.7★5 IJ (13%) · 1 abuse (3%)$473.8M$74.8M0%+6.7%
51AVARDIS HEALTH383,96842.0★15 IJ (39%) · 1 SFF (3%) · 9 abuse (24%)$365.1M$18.9M0%+1.1%
52CENTRAL ARKANSAS NURSING CENTERS384,14523.6★6 IJ (16%) · 1 abuse (3%)$371.9M$70.2M0%+7.9%
53LONGWOOD MANAGEMENT CORPORATION384,42012.2★13 IJ (34%) · 3 abuse (8%)$559.0M$54.7M0%-0.4%
54PRIORITY MANAGEMENT385,05122.9★10 IJ (26%) · 3 abuse (8%)$415.3M$57.4M0%-4.0%
55CANTEX CONTINUING CARE374,39913.1★16 IJ (43%) · 3 abuse (8%)$287.4M$100%-5.2%
56CAREONE375,21743.4★3 IJ (8%) · 1 abuse (3%)$675.3M$103.6M0%-4.2%
57LIBERTY SENIOR LIVING REIT 2/37373,89822.8★10 IJ (27%) · 1 abuse (3%)$393.0M$94.1M0%-5.1%
58CENTERS HEALTH CARE366,45522.2★4 IJ (11%) · 6 abuse (17%)$934.5M$92.7M0%-1.2%
59CIRCLE B ENTERPRISES363,54922.5★5 IJ (14%) · 3 abuse (8%)$173.0M$44.5M0%+0.1%
60GOLD FL TRUST II364,37713.4★11 IJ (31%)$507.9M$4.9M0%+1.8%

Large chains rating furthest below their own states

Chains of 10 or more homes whose portfolio rates furthest below the average of the states they operate in. Two corrections a raw “lowest average” ranking gets wrong. Where they operate: CMS ranks the health-inspection star within each state, so a chain concentrated in a low-rating state is not thereby a worse operator — each is measured against its own states’ average, which is why a 2-star chain in a 3.5-star state outranks a 2-star chain in a 2-star state here. How many homes they run: a 10-home average is roughly three times noisier than a 200-home one, so smaller chains are pulled toward that local expectation before ranking. The average shown is always the raw observed one, with a ±95% interval. What survives both corrections is the investigative lede: a portfolio rating below its own states’ norm, across many homes, points at the operator and not at one unlucky building.

RELIANT CARE MANAGEMENT
34 homes · 2 states · avg 1.2★ ±0.2 · vs ~2.5 avg in its states · 17 IJ (50% of homes) · 1 SFF (3% of homes) · 14 abuse (41% of homes)
HILL VALLEY HEALTHCARE
43 homes · 6 states · avg 1.8★ ±0.3 · vs ~3.0 avg in its states · 15 IJ (35% of homes) · 7 abuse (16% of homes)
ATHENA HEALTHCARE SYSTEMS
22 homes · 3 states · avg 1.5★ ±0.3 · vs ~3.0 avg in its states · 3 IJ (14% of homes) · 4 abuse (18% of homes)
EASTERN HEALTHCARE GROUP
18 homes · 1 state · avg 1.5★ ±0.3 · vs ~3.0 avg in its states · 7 IJ (39% of homes) · 5 abuse (28% of homes)
ARCADIA CARE
25 homes · 2 states · avg 1.3★ ±0.3 · vs ~2.6 avg in its states · 14 IJ (56% of homes) · 2 SFF (8% of homes) · 10 abuse (40% of homes)
THE CHARLY BELLO FAMILY, THE MAZE FAMILY, THE SWAIN FAMILY, & WALTER MYERS
19 homes · 3 states · avg 1.7★ ±0.4 · vs ~3.0 avg in its states · 9 IJ (47% of homes) · 7 abuse (37% of homes)
EPHRAM LAHASKY
22 homes · 9 states · avg 1.8★ ±0.4 · vs ~3.1 avg in its states · 11 IJ (50% of homes) · 2 SFF (9% of homes) · 3 abuse (14% of homes)
EMERALD HEALTHCARE
14 homes · 3 states · avg 1.3★ ±0.3 · vs ~2.7 avg in its states · 8 IJ (57% of homes) · 1 abuse (7% of homes)
INFINITY HEALTHCARE CONSULTING
69 homes · 3 states · avg 2.0★ ±0.3 · vs ~3.0 avg in its states · 17 IJ (25% of homes) · 1 SFF (1% of homes) · 16 abuse (23% of homes)
AVENTURA HEALTH GROUP
11 homes · 3 states · avg 1.5★ ±0.4 · vs ~3.1 avg in its states · 6 IJ (55% of homes) · 1 SFF (9% of homes) · 1 abuse (9% of homes)
MONARCH HEALTHCARE MANAGEMENT
45 homes · 1 state · avg 2.2★ ±0.3 · vs ~3.2 avg in its states · 14 IJ (31% of homes) · 6 abuse (13% of homes)
LONGWOOD MANAGEMENT CORPORATION
38 homes · 1 state · avg 2.2★ ±0.4 · vs ~3.2 avg in its states · 13 IJ (34% of homes) · 3 abuse (8% of homes)
LIFEWORKS REHAB
64 homes · 5 states · avg 2.1★ ±0.3 · vs ~3.0 avg in its states · 26 IJ (41% of homes) · 3 SFF (5% of homes) · 11 abuse (17% of homes)
CASCADES HEALTHCARE
19 homes · 4 states · avg 1.9★ ±0.4 · vs ~3.1 avg in its states · 7 IJ (37% of homes) · 5 abuse (26% of homes)
ALLIANCE HEALTH GROUP
12 homes · 1 state · avg 1.5★ ±0.5 · vs ~2.9 avg in its states · 5 IJ (42% of homes) · 2 abuse (17% of homes)
CERTUS HEALTHCARE
14 homes · 2 states · avg 1.8★ ±0.3 · vs ~3.1 avg in its states · 6 IJ (43% of homes) · 1 SFF (7% of homes) · 4 abuse (29% of homes)
NEXT STEP HEALTHCARE
14 homes · 1 state · avg 1.7★ ±0.6 · vs ~3.0 avg in its states · 2 IJ (14% of homes) · 1 abuse (7% of homes)
PACIFIC HEALTHCARE HOLDINGS
15 homes · 1 state · avg 1.9★ ±0.6 · vs ~3.2 avg in its states · 6 IJ (40% of homes) · 1 abuse (7% of homes)
THE ORCHARDS MICHIGAN
15 homes · 1 state · avg 1.9★ ±0.7 · vs ~3.1 avg in its states · 2 IJ (13% of homes) · 3 abuse (20% of homes)
THE GRAND HEALTHCARE
16 homes · 1 state · avg 1.8★ ±0.5 · vs ~3.0 avg in its states · 7 IJ (44% of homes) · 1 abuse (6% of homes)
POINTE MANAGEMENT
12 homes · 3 states · avg 1.2★ ±0.4 · vs ~2.6 avg in its states · 3 IJ (25% of homes) · 5 abuse (42% of homes)
AVARDIS HEALTH
38 homes · 4 states · avg 2.0★ ±0.4 · vs ~2.9 avg in its states · 15 IJ (39% of homes) · 1 SFF (3% of homes) · 9 abuse (24% of homes)
AVIATA HEALTH GROUP
50 homes · 1 state · avg 2.4★ ±0.3 · vs ~3.3 avg in its states · 16 IJ (32% of homes) · 8 abuse (16% of homes)
VOLARE HEALTH
16 homes · 3 states · avg 1.8★ ±0.6 · vs ~3.0 avg in its states · 5 IJ (31% of homes) · 2 SFF (12% of homes) · 2 abuse (12% of homes)
YAD HEALTHCARE
13 homes · 3 states · avg 1.7★ ±0.6 · vs ~2.9 avg in its states · 6 IJ (46% of homes) · 1 SFF (8% of homes) · 2 abuse (15% of homes)
FLORIDA INSTITUTE FOR LONG-TERM CARE
17 homes · 1 state · avg 2.2★ ±0.5 · vs ~3.3 avg in its states · 7 IJ (41% of homes) · 1 abuse (6% of homes)
KADIMA HEALTHCARE GROUP
14 homes · 1 state · avg 1.8★ ±0.6 · vs ~3.0 avg in its states · 6 IJ (43% of homes) · 1 SFF (7% of homes) · 2 abuse (14% of homes)
LYON HEALTHCARE
11 homes · 2 states · avg 1.7★ ±0.5 · vs ~3.0 avg in its states · 6 IJ (55% of homes) · 1 abuse (9% of homes)
CAMPBELL STREET SERVICES PE ties at 1 of 22
22 homes · 3 states · avg 2.1★ ±0.6 · vs ~3.1 avg in its states · 8 IJ (36% of homes) · 1 SFF (5% of homes) · 3 abuse (14% of homes)
SERRANO GROUP
11 homes · 1 state · avg 1.9★ ±0.6 · vs ~3.2 avg in its states · 5 IJ (45% of homes) · 3 abuse (27% of homes)
HARBORVIEW HEALTH SYSTEMS
22 homes · 3 states · avg 1.9★ ±0.3 · vs ~2.9 avg in its states · 6 IJ (27% of homes) · 1 SFF (5% of homes) · 2 abuse (9% of homes)
CENTERS HEALTH CARE
36 homes · 2 states · avg 2.2★ ±0.4 · vs ~3.0 avg in its states · 4 IJ (11% of homes) · 6 abuse (17% of homes)
JOURNEY HEALTHCARE REIT ties at 3 of 32
32 homes · 4 states · avg 1.9★ ±0.4 · vs ~2.8 avg in its states · 7 IJ (22% of homes) · 1 SFF (3% of homes)
UPSTATE SERVICES GROUP
17 homes · 1 state · avg 2.0★ ±0.6 · vs ~3.0 avg in its states · 3 IJ (18% of homes) · 1 SFF (6% of homes) · 1 abuse (6% of homes)
APERION CARE
33 homes · 2 states · avg 1.9★ ±0.5 · vs ~2.8 avg in its states · 7 IJ (21% of homes) · 10 abuse (30% of homes)
GENESIS HEALTHCARE
184 homes · 18 states · avg 2.4★ ±0.2 · vs ~3.0 avg in its states · 69 IJ (38% of homes) · 4 SFF (2% of homes) · 27 abuse (15% of homes)
ELIYAHU MIRLIS
13 homes · 3 states · avg 2.1★ ±0.7 · vs ~3.2 avg in its states · 6 IJ (46% of homes) · 2 abuse (15% of homes)
OPTALIS HEALTH & REHABILITATION
36 homes · 2 states · avg 2.4★ ±0.4 · vs ~3.1 avg in its states · 11 IJ (31% of homes) · 9 abuse (25% of homes)
BEACON HEALTH MANAGEMENT
11 homes · 2 states · avg 1.5★ ±0.5 · vs ~2.7 avg in its states · 3 IJ (27% of homes) · 1 abuse (9% of homes)
THE BLOSSOMS REHAB & NURSING CENTER
23 homes · 1 state · avg 2.6★ ±0.6 · vs ~3.4 avg in its states · 2 IJ (9% of homes) · 3 abuse (13% of homes)
CONTINUING HEALTHCARE SOLUTIONS
12 homes · 1 state · avg 2.1★ ±0.5 · vs ~3.2 avg in its states · 2 IJ (17% of homes) · 2 abuse (17% of homes)
WECARE CENTERS PE ties at 9 of 13
13 homes · 2 states · avg 1.9★ ±0.7 · vs ~3.0 avg in its states · 5 IJ (38% of homes) · 1 SFF (8% of homes) · 2 abuse (15% of homes)
BRIA HEALTH SERVICES
10 homes · 1 state · avg 1.4★ ±0.4 · vs ~2.5 avg in its states · 6 IJ (60% of homes) · 6 abuse (60% of homes)
AJC HEALTHCARE
14 homes · 1 state · avg 2.2★ ±0.5 · vs ~3.2 avg in its states · 5 IJ (36% of homes) · 1 SFF (7% of homes) · 5 abuse (36% of homes)
CHAMPION CARE
22 homes · 3 states · avg 2.2★ ±0.5 · vs ~3.0 avg in its states · 10 IJ (45% of homes) · 1 SFF (5% of homes) · 1 abuse (5% of homes)
AYDEN HEALTHCARE
11 homes · 1 state · avg 2.1★ ±0.7 · vs ~3.2 avg in its states · 2 IJ (18% of homes)
FOCUSED POST ACUTE CARE PARTNERS
25 homes · 1 state · avg 1.9★ ±0.4 · vs ~2.6 avg in its states · 17 IJ (68% of homes) · 7 abuse (28% of homes)
EXCELSIOR CARE GROUP
33 homes · 3 states · avg 2.5★ ±0.4 · vs ~3.2 avg in its states · 8 IJ (24% of homes) · 2 abuse (6% of homes)
ADVINIACARE
11 homes · 3 states · avg 2.0★ ±0.6 · vs ~3.0 avg in its states · 6 IJ (55% of homes) · 2 abuse (18% of homes)
EMBASSY HEALTHCARE PE ties at 6 of 33
33 homes · 2 states · avg 2.4★ ±0.4 · vs ~3.1 avg in its states · 10 IJ (30% of homes) · 3 abuse (9% of homes)

Every chain, A–Z

All 590 chains of three or more homes, alphabetically — the rankings above show only the largest and the lowest-rated.

# · A · B · C · D · E · F · G · H · I · J · K · L · M · N · O · P · Q · R · S · T · U · V · W · Y

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Source: CMS Provider Data Catalog (nursing-home ratings, deficiencies, penalties, and ownership) and the CMS Medicare cost report (HCRIS) for finances. Chain membership is as reported to CMS. CMS extracts retrieved 30 August 2026; CMS refreshes them monthly, so counts here are as of that date. Verify with the facility and your state regulator.