Organization Active NPI

Vernon Manor SNF Operations LLC

  • Skilled Nursing Facility
  • Vernon, CT
National Provider Identifier
1053045294
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
VERNON MANOR SNF OPERATIONS LLC
Practice address
180 Regan Rd
Vernon, CT 06066-2824
Phone
(860) 871-0385
NPI assigned
Jul 13, 2022
Last updated
Jul 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

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

Authorized official

Name
Pinchos Bak
Title
Authorized Representative
Phone
(908) 783-3110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

180 Regan Rd
Vernon, CT 06066-2824

Mailing address

180 Regan Rd
Vernon, CT 06066-2824

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220914003259 CT Part A Provider - Skilled Nursing Facility 8022493824 Practice locations: Vernon, CT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053045294. Details of each certification follow.

Skilled nursing facility certification: CCN 075334

Legal name
VERNON MANOR SNF OPERATIONS LLC
Doing business as
VERNON REHABILITATION AND HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 17, 1990
Last certification
Oct 11, 2024
Beds
120
Ownership / control type
Corporation
Multi-facility organization
ATLAS HEALTHCARE
Most recent change of ownership
Jul 27, 2022
Organization structure
LLCProprietary
Enrollment address
180 Regan Rd
Vernon, CT 06066-2824
Nursing home name
VERNON REHABILITATION AND HEALTHCARE CENTER
Affiliated entity
ATLAS HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Vernon Rehabilitation and Healthcare CenterCCN 075334 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jan 17, 1990
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120115.1 residents per day on average
Chain
Atlas Healthcare29 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
07D0093268Vernon Manor SNF Operations LLC180 Regan Rd, Vernon, CT 06066Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

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.

NameRoleSinceShare
Tyh 2017 Trust Organization, Jackson, NJ For-profit Limited Partnership Interest Jul 27, 2022
Vernon Manor SNF Realty LLC Organization, Lakewood, NJ LLC, For-profit Adp of the SNF Jul 15, 2025
Kristi Dougherty Individual Operational/Managerial Control Jul 27, 2022
Adp of the SNF Jul 27, 2022
Shlomo Goldberger Individual Operational/Managerial Control Jul 27, 2022
Adp of the SNF Jul 27, 2022
JS Evans Investments LLC Organization, Oak Park, IL LLC, Investment firm, For-profit, Owned by another organization or individual Limited Partnership Interest Jul 27, 2022
JMH Family Trust Organization, Lakewood, NJ For-profit 5% Or Greater Indirect Ownership Interest Jul 27, 2022 22.8%
Limited Partnership Interest Jul 27, 2022
Adp of the SNF Jul 27, 2022
CT-3 Operations Holdings LLC Organization, Toms River, NJ Created for acquisition, LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jul 27, 2022 100%
Individual Trustee of the SNF Jul 27, 2022
Tamlyn Campanelli Individual Operational/Managerial Control Jul 27, 2022
Adp of the SNF Jul 27, 2022
Pinchos Z Bak Individual Corporate OfficerPresident Jul 27, 2022
Operational/Managerial Control Jul 27, 2022
Adp of the SNF Jul 27, 2022
Moshe Gottlieb Individual 5% Or Greater Indirect Ownership Interest Jul 27, 2022 24%
Limited Partnership Interest Jul 27, 2022
Operational/Managerial Control Jul 27, 2022
Adp of the SNF Jul 27, 2022
Kristin Giannini Individual Operational/Managerial Control Jul 27, 2022
Adp of the SNF Jul 27, 2022
MLS Family LLC Organization, Toms River, NJ LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 27, 2022 24%
Limited Partnership Interest Jul 27, 2022
Adp of the SNF Jul 27, 2022
Individual Trustee of the SNF Jul 27, 2022
SGS Family LLC Organization, Toms River, NJ LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 27, 2022 24%
Limited Partnership Interest Jul 27, 2022
Adp of the SNF Jul 27, 2022
MLS Family Trust Organization, Lakewood, NJ For-profit 5% Or Greater Indirect Ownership Interest Jul 27, 2022 22.8%
Limited Partnership Interest Jul 27, 2022
Adp of the SNF Jul 27, 2022
CT-3 Opco Manager LLC Organization, Toms River, NJ LLC, For-profit Operational/Managerial Control Jul 27, 2022
Adp of the SNF Jul 15, 2025
JMH Family LLC Organization, Toms River, NJ LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 27, 2022 24%
Limited Partnership Interest Jul 27, 2022
Adp of the SNF Jul 27, 2022
SGS Family Trust Organization, Lakewood, NJ For-profit 5% Or Greater Indirect Ownership Interest Jul 27, 2022 22.8%
Limited Partnership Interest Jul 27, 2022
Adp of the SNF Jul 27, 2022
Moshe Sonnenschein Individual Operational/Managerial Control Jul 27, 2022
Trustee of the SNF Jul 27, 2022
Adp of the SNF Jul 27, 2022
SGS 2010 Family Trust Organization, Toms River, NJ For-profit Limited Partnership Interest Jul 27, 2022
Av SNF Realty Holdings LLC Organization, Lakewood, NJ LLC, Holding company, For-profit Adp of the SNF Jul 27, 2022
Individual Trustee of the SNF Jul 27, 2022
Malt Family Trust Organization, Lakewood, NJ For-profit Limited Partnership Interest Jul 27, 2022

Owners & managing parties with NPI records 1

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

Facilities with the same owner 18

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

View all 18

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": "1657670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657670400000",
    "number": "1053045294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 REGAN RD",
            "city": "VERNON",
            "state": "CT",
            "postal_code": "060662824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 REGAN RD",
            "city": "VERNON",
            "state": "CT",
            "postal_code": "060662824",
            "telephone_number": "860-871-0385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VERNON MANOR SNF OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-13",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A",
        "authorized_official_last_name": "BAK",
        "authorized_official_first_name": "PINCHOS",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "908-783-3110"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vernon, CT

Sources for this page

Verify at the official NPI Registry.