Crystal Rehab & Nursing LLC
Organization Active NPI Skilled Nursing Facility · Webster, MA
NPI 1023535929 · NPPES record last updated Dec 14, 2020
Key facts
- NPI
- 1023535929
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- CRYSTAL REHAB & NURSING LLC
- Practice address
- 11 Pontiac Ave
Webster, MA 01570-1629 - Phone
- (508) 943-3889
- NPI assigned
- Aug 23, 2017
- Organization subpart
- No
Authorized official
- Name
- Shimmy Leibes
- Title
- Memebr
- Phone
- (516) 588-8811
Facilities with the same owner 4
Practitioners 3
-
Peter J Dain, M.D.
-
David W Duhme, M.D.
-
Julius Tanyi V Tabe, M.D
Affiliated clinicians 2
-
Peter J Dain, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Brookside Rehabilitation and Healthcare Center
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★☆☆☆☆ 1 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jul 1, 1990
- Medicare certification status
- Active
- Certified beds
- 81 · 67.9 residents per day on average
- Chain
- Ephram Lahasky
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
Skilled nursing facility certification: CCN 225483
- Legal name
- CRYSTAL REHAB & NURSING LLC
- Doing business as
- BROOKSIDE REHABILITATION AND HEALTHCARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 1, 1990
- Last certification
- May 2, 2024
- Beds
- 81
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- May 16, 2017 in MA
- Enrollment address
- 11 Pontiac Ave
Webster, MA 01570-1629 - Nursing home name
- BROOKSIDE REHABILITATION AND HEALTHCARE CENTER
- Affiliated entity
- EPHRAM LAHASKY
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Michael M Biderman |
5% Or Greater Direct Ownership Interest | May 16, 2017 | 42% |
| Operational/Managerial Control |
May 16, 2017 | ||
| Ephram M Lahasky |
5% Or Greater Direct Ownership Interest |
May 16, 2017 | |
| Operational/Managerial Control |
May 16, 2017 | ||
| Yehuda Biderman |
5% Or Greater Direct Ownership Interest | May 16, 2017 | 10% |
| BNB Health Care Funds LLC |
5% Or Greater Direct Ownership Interest | May 16, 2017 | 7% |
| Tova L Fuchs |
5% Or Greater Direct Ownership Interest | May 16, 2017 | 5% |
| Brian Kohn |
5% Or Greater Direct Ownership Interest | May 16, 2017 | 6% |
| Mark Presutti |
W-2 Managing Employee | Jul 24, 2017 | |
| Bradley Martin |
5% Or Greater Direct Ownership Interest | May 16, 2017 | 5% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171121000072 | MA | Part a Provider - Skilled Nursing Facility | 0547527905 | Practice locations: Webster, MA |
National Provider Directory
Locations
11 Pontiac Ave
Webster, MA 01570
Phone (508) 943-3889
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
11 Pontiac Ave
Webster, MA 01570-1629
Mailing address
11 Pontiac Ave
Webster, MA 01570-1629
Phone (508) 943-3889
Other names
- Brookside Rehabilitation and Healthcare Center
Other providers in Webster, MA
- Colonial Health Group- Tcu, LLC
- Olivia Corfey
- Laurenmarie Cormier
- Jason Val Corriveau
- Tina M Crentsil
- CVS Pharmacy Inc
- Nicholas David Cyrek
- Afia Dansoaah
- Mark Benjamin Davidson
- Beverly Debruyn
All providers in Webster, MA · Skilled Nursing Facility in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 14, 2020. 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.