NPIMap

Organization Active NPI

Southern Pines Nursing Center LLC

  • Skilled Nursing Facility
  • New Port Richey, FL
National Provider Identifier
1033844378
Registry record updated Jul 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SOUTHERN PINES NURSING CENTER LLC
Practice address
6140 Congress St
New Port Richey, FL 34653-3909
Phone
(727) 842-8402
Fax
(727) 841-8060
NPI assigned
Jul 20, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2022

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

Authorized official

Name
Mathew Varghese
Title
Member
Phone
(917) 817-3530

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

6140 Congress St
New Port Richey, FL 34653-3909

Mailing address

6140 Congress St
New Port Richey, FL 34653-3909
Phone (727) 842-8402

Other identifiers 1

IdentifierTypeStateIssuer
15060961OtherFLLICENSE

Other names 1

  • Southern Pines Nursing Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://southernpineshealthcare.com/

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221209001188 FL Part A Provider - Skilled Nursing Facility 3870962046 Practice locations: New Port Richey, FL

Skilled nursing facility certification: CCN 105275

Legal name
SOUTHERN PINES NURSING CENTER LLC
Doing business as
SOUTHERN PINES NURSING CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 27, 1978
Last certification
Oct 19, 2023
Beds
120
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
Oct 8, 2022
Organization structure
LLCProprietary
Incorporated
Jul 7, 2022 in FL
Enrollment address
6140 Congress St
New Port Richey, FL 34653-3909
Nursing home name
SOUTHERN PINES NURSING CENTER
Affiliated entity
BENJAMIN LANDA

Care Compare: Nursing home

Medicare Care Compare
Listed as
Southern Pines Nursing CenterCCN 105275
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Oct 27, 1978
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12093.4 residents per day on average
Chain
Benjamin Landa48 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0881352Southern Pines Nursing Center LLC6140 Congress St, New Port Richey, FL 34653Certificate of waiverOct 24, 2027

National Provider Directory

National Provider Directory

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Tricia Thacker Individual Corporate OfficerCeo Apr 4, 2022
Mayer Fischel Individual 5% Or Greater Indirect Ownership Interest Oct 8, 2022 10%
Aston Healthcare LLC Organization, Tampa, FL LLC, For-profit, Chain home office Adp of the SNF Mar 15, 2025
ZBL-18 LLC Organization, Brooklyn, NY Created for acquisition, LLC, For-profit 5% Or Greater Indirect Ownership Interest Oct 8, 2022 10%
Southern Pines Nursing Member LLC Organization, New Port Richey, FL Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Oct 7, 2022 100%
Erin Kwapil Individual Operational/Managerial Control Nov 4, 2024
Adp of the SNF Mar 15, 2025
Heidi-Lynn Francis Wilson Individual Operational/Managerial Control Feb 25, 2025
Tampa 2 Opco Partners LLC Organization, Woodmere, NY Created for acquisition, LLC, For-profit 5% Or Greater Indirect Ownership Interest Oct 8, 2022 100%
Victoria Fortino Individual Operational/Managerial Control Dec 24, 2023
Benjamin Landa Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2023 75%
Corporate OfficerMember Oct 8, 2022
Flnho Capital Group LLC Organization, Mineola, NY LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Oct 8, 2022 75%

Facilities with the same owner 29

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 29

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1658275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658275200000",
    "number": "1033844378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6140 CONGRESS ST",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346533909",
            "telephone_number": "727-842-8402",
            "fax_number": "727-841-8060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6140 CONGRESS ST",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346533909",
            "telephone_number": "727-842-8402",
            "fax_number": "727-841-8060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PINES NURSING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-20",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "VARGHESE",
        "authorized_official_first_name": "MATHEW",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "917-817-3530"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "15060961",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://southernpineshealthcare.com/",
            "affiliation": "N",
            "address_1": "6140 Congress St",
            "city": "New Port Richey",
            "state": "FL",
            "country_code": "US",
            "postal_code": "346533909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Southern Pines Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Port Richey, FL

Sources for this page

Verify at the official NPI Registry.