St Luke's Home Residential Healthcare Facility Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

3227305N Issued in NY

Legal business name

ST LUKE'S HOME RESIDENTIAL HEALTHCARE FACILITY INC

Doing business as

MVHS Rehabilitation and Nursing Center

Practice address

1650 Champlin Ave
Utica, NY 13502

Phone

(315) 624-8600

NPI assigned

Oct 10, 2006

Last updated

Jul 27, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cody White

Title

Executive Director

Phone

(315) 801-4429

Specialties & licenses 1

Addresses

Other names 1

• MVHS Rehabilitation and Nursing Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003904863. Details of each certification follow.

• CCN 335801 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 335801

Legal name

ST LUKE'S HOME RESIDENTIAL HEALTH CARE FACILITY INC

Doing business as

MVHS REHABILITATION & NURSING HOME

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Sep 4, 1996

Last certification

Oct 25, 2023

Beds

202

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Enrollment address

1650 Champlin Ave
Utica, NY 13502-4801

Nursing home name

MVHS REHABILITATION AND NURSING CENTER

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• St Luke's Home Residential Health Care Facility Inc

  dba MVHS Rehabilitation & Nursing Home

  • Skilled Nursing Facility
  • Utica, NY
  • NPI 1548331143

  O20061004000136

  Same enrollment
• St Luke's Residential Healthcare Facility Inc

  dba MVHS Rehabilitation and Nursing Center

  • Skilled Nursing Facility
  • Utica, NY
  • NPI 1578578126

  O20061004000136

  Same enrollment

Listed as

MVHS Rehabilitation and Nursing CenterCCN 335801 · All quality measures

Overall star rating

3 of 5

Health inspections

3 of 5

Staffing

3 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Sep 4, 1996

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

202193.9 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Locations

All disclosed owners & managing parties 24

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Domenic P Aiello, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • New Hartford, NY
  • NPI 1679547111

  Corporate Director

  CMS ownership
• Hamerton David Jeanty, M.D.

  • Hospitalist Physician
  • Utica, NY
  • NPI 1215297882

  Adp of the SNF, Corporate Officer, Operational/Managerial Control

  CMS ownership
• Sushma Kaul, MD

  • Pulmonary Disease Physician
  • Utica, NY
  • NPI 1952317091

  Corporate Officer

  CMS ownership

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658880000000",
    "number": "1003904863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2209 GENESEE ST OFC ROOM315",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135015930",
            "telephone_number": "315-801-3282",
            "fax_number": "315-801-8391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 CHAMPLIN AVE",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "13502",
            "telephone_number": "315-624-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKE'S HOME RESIDENTIAL HEALTHCARE FACILITY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "CODY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "315-801-4429"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "3227305N",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MVHS Rehabilitation and Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• St Elizabeth Medical Center (MVHS Inc)
• St Elizabeth Medical Center (MVHS Inc)
• St Elizabeth Medical Center (MVHS Inc)
• St Elizabeth's Homecare Inc
• St Luke's Home Residential Health Care Facility Inc (MVHS Rehabilitation & Nursing Home)
• St Luke's Home Residential Healthcare Facility Inc (MVHS Rehabilitation and Nursing Center)
• St Luke's Residential Healthcare Facility Inc (MVHS Rehabilitation and Nursing Center)
• St Regis Medical Equipment Corp
• St. Joseph Nursing Home Co. of Utica (St. Joseph Nursing Home)
• Heidi Stabb

• Skilled Nursing Facility in Utica, NY
• Providers in Utica, NY by specialty
• Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.