NPIMap

Organization Active NPI

Hillside Manor Rehabilitation and Extended Care Center, LLC

  • Skilled Nursing Facility
  • Jamaica, NY
National Provider Identifier
1043392657
Registry record updated Sep 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
HILLSIDE MANOR REHABILITATION AND EXTENDED CARE CENTER, LLC
Practice address
18215 Hillside Ave
Jamaica, NY 11432-4853
Phone
(718) 291-8200
Fax
(718) 262-8651
NPI assigned
Oct 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2008

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

Authorized official

Name
Mr. Doug Wissmann
Title
Finance Director
Phone
(718) 291-8200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

18215 Hillside Ave
Jamaica, NY 11432-4853

Mailing address

18215 Hillside Ave
Jamaica, NY 11432-4853
Phone (718) 291-8200

Other identifiers 1

IdentifierTypeStateIssuer
00318025MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111201000053 NY Part A Provider - Skilled Nursing Facility 8628034634 Practice locations: Jamaica, NY

Skilled nursing facility certification: CCN 335531

Legal name
HILLSIDE MANOR REHABILITATION AND EXTENDED CARE CENTER LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 22, 1975
Last certification
Mar 31, 2025
Beds
400
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
18215 Hillside Ave
Jamaica, NY 11432-4853
Nursing home name
HILLSIDE MANOR REHAB & EXTENDED CARE CENTER

Care Compare: Nursing home

Medicare Care Compare
Listed as
Hillside Manor Rehab & Extended Care CenterCCN 335531
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Dec 22, 1975
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
400380.8 residents per day on average
Penalties (3 years)
1Fines totaling $34,947

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Hillside Manor Adult Day Health Care Program2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Individual Adp of the SNF Jan 1, 2006
Jeffrey Jackson Individual 5% Or Greater Direct Ownership InterestController Oct 1, 2019 6.73%
Managing Control - Governing BodyController Oct 1, 2019
Adp of the SNF Oct 1, 2019
Douglas Wissmann Individual 5% Or Greater Direct Ownership InterestMember Sep 27, 2012 12.86%
Managing Control - Governing BodyCfo Sep 27, 2012
Adp of the SNF Sep 27, 2012
Gayathri Hariharan Individual Operational/Managerial Control Dec 31, 2024
Adp of the SNF Dec 31, 2024
Individual Adp of the SNF Jan 1, 2006
HMM & Co., LLP Organization, Hauppauge, NY For-profit Adp of the SNF Jan 1, 2007
Individual Adp of the SNF Jan 1, 2006
Himanshu Pandya Individual Operational/Managerial Control Oct 17, 2011
Adp of the SNF Oct 17, 2011
Bowne Associates, LLC Organization, Jamaica, NY LLC Adp of the SNF Jan 7, 1972
S&J Management II, Inc. Organization, Highland, NY Corporation Adp of the SNF Jul 1, 2022
Floral Park Medical PC Organization, Roslyn, NY Medical provider/supplier Adp of the SNF Jun 1, 2018
Estate of Marcia Trupin Organization, Jamaica, NY Adp of the SNF Jan 7, 1972
Individual Adp of the SNF Jan 1, 2006
Organization, Jamaica, NY Adp of the SNF Jan 7, 1972
Individual Adp of the SNF Jan 1, 2006
Individual Adp of the SNF Jan 1, 2006
Meryl Dicker Individual 5% Or Greater Direct Ownership Interest Sep 27, 2012 80.41%
Managing Control - Governing Body Sep 27, 2012
Adp of the SNF Sep 27, 2012

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 7

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": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222041600000",
    "number": "1043392657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18215 HILLSIDE AVE",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114324853",
            "telephone_number": "718-291-8200",
            "fax_number": "718-262-8651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18215 HILLSIDE AVE",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114324853",
            "telephone_number": "718-291-8200",
            "fax_number": "718-262-8651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HILLSIDE MANOR REHABILITATION AND EXTENDED CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2008-09-22",
        "status": "A",
        "authorized_official_last_name": "WISSMANN",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "718-291-8200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00318025",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

Verify at the official NPI Registry.