NPIMap

Organization Active NPI

Gwynnfalls MD Opco

Doing business as Carroll Park Healthcare

  • Skilled Nursing Facility
  • Baltimore, MD
National Provider Identifier
1013615681
Registry record updated Sep 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
GWYNNFALLS MD OPCO
Doing business as
Carroll Park Healthcare
Practice address
3330 Wilkens Ave
Baltimore, MD 21229-4610
Phone
(410) 525-1544
NPI assigned
Feb 22, 2023
Last updated
Sep 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2023

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

Authorized official

Name
Jack Paneth
Title
Authorized Official
Phone
(410) 525-1544

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

3330 Wilkens Ave
Baltimore, MD 21229-4610

Mailing address

3330 Wilkens Ave
Baltimore, MD 21229-4610
Phone (410) 655-7373

Other names 1

  • Carroll Park Healthcare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231227003217 MD Part A Provider - Skilled Nursing Facility 6406206812 Practice locations: Baltimore, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013615681. Details of each certification follow.

Skilled nursing facility certification: CCN 215085

Legal name
GWYNNFALLS MD OPCO
Doing business as
CARROLL PARK HEALTHCARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 11, 1972
Last certification
Nov 20, 2023
Beds
140
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Engage Healthcare
Organization structure
LLCProprietary
Enrollment address
3330 Wilkens Ave
Baltimore, MD 21229-4610
Nursing home name
CARROLL PARK HEALTHCARE
Affiliated entity
ENGAGE HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Carroll Park HealthcareCCN 215085 · All quality measures
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 11, 1972
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
14095.8 residents per day on average
Chain
Engage Healthcare5 facilities in the chain
Special focus status
SFF
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
2Fines totaling $306,550

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Jake Lighten Individual 5% Or Greater Indirect Ownership Interest Aug 1, 2023 50%
Operational/Managerial Control Aug 1, 2023
Gwynnfalls MD Holdco LLC Organization, Baltimore, MD Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Aug 1, 2023 100%
Jack Paneth Individual 5% Or Greater Indirect Ownership Interest Aug 1, 2023 50%
Yechiel Kuritsky Individual W-2 Managing Employee Aug 1, 2023

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1677024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694304000000",
    "number": "1013615681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3330 WILKENS AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212294610",
            "telephone_number": "410-655-7373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 WILKENS AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212294610",
            "telephone_number": "410-525-1544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GWYNNFALLS MD OPCO",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-22",
        "last_updated": "2023-09-10",
        "certification_date": "2023-09-10",
        "status": "A",
        "authorized_official_last_name": "PANETH",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "410-525-1544"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carroll Park Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Carroll Park Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.