Blountstown FL Operator LLC
Organization Active NPI Skilled Nursing Facility · Blountstown, FL
NPI 1003569385 · NPPES record last updated Jan 27, 2022
Key facts
- NPI
- 1003569385
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- BLOUNTSTOWN FL OPERATOR LLC
- Practice address
- 16690 SW Chipola Rd
Blountstown, FL 32424-1953 - Phone
- (917) 295-1882
- NPI assigned
- Jan 27, 2022
- Organization subpart
- No
Authorized official
- Name
- Robert Kolman, LNHA
- Title
- Operator
- Phone
- (917) 295-1882
Owners & managing parties with NPI records 1
-
Misbah I Farooqi, M.D.
Affiliated clinicians 2
-
Misbah I Farooqi, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Blountstown Health and Rehabilitation Center
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★★☆ 4 of 5
- Staffing
- ★★★★★ 5 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Aug 1, 1996
- Medicare certification status
- Active
- Certified beds
- 96 · 86.0 residents per day on average
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D0916212 | Blountstown FL Operator LLC | Certificate of waiver | Jun 17, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Skilled nursing facility certification: CCN 105924
- Legal name
- BLOUNTSTOWN FL OPERATOR LLC
- Doing business as
- BLOUNTSTOWN HEALTH AND REHABILITATION CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 1, 1996
- Last certification
- Aug 15, 2024
- Beds
- 96
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC · Proprietary
- Enrollment address
- 16690 SW Chipola Rd
Blountstown, FL 32424-1953 - Nursing home name
- BLOUNTSTOWN HEALTH AND REHABILITATION CENTER
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Mathew K Varghese |
5% Or Greater Direct Ownership Interest |
Sep 10, 2021 | 100% |
| Grant Williams |
Operational/Managerial Control | Feb 15, 2022 | |
| Adp of the SNF | Feb 15, 2022 | ||
| Misbah Ul Farooqi |
Operational/Managerial Control | Feb 15, 2022 | |
| Adp of the SNF | Feb 15, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220106000439 | FL | Part a Provider - Skilled Nursing Facility | 7810388519 | Practice locations: Blountstown, FL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
16690 SW Chipola Rd
Blountstown, FL 32424-1953
Mailing address
16690 SW Chipola Rd
Blountstown, FL 32424-1953
Other names
- Blountstown Health and Rehabilitation Center
Other providers in Blountstown, FL
- Nan Melvin Barfield
- Nicholas Barth
- Chauncey L Belser
- Bittern Emergency Physicians, LLC
- Blountstown Drug Inc.
- Blountstown Health & Rehabilitation Center, LLC
- Blountstown Rehabilitation Center, LLC
- Blountstown SNF Operations LLC
- Taylor Boyd
- Clifford Stuart Bristol
All providers in Blountstown, FL · Skilled Nursing Facility in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.