NPIMap

Organization Active NPI

200 Governors Opco LLC

  • Skilled Nursing Facility
  • Medford, MA
National Provider Identifier
1053178582
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
200 GOVERNORS OPCO LLC
Practice address
200 Governors Ave
Medford, MA 02155-1644
Phone
(781) 391-5400
NPI assigned
Mar 1, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Authorized official

Name
Eliyahu Mirlis
Title
Owner
Phone
(732) 961-8491

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

200 Governors Ave
Medford, MA 02155-1644

Mailing address

200 Governors Ave
Medford, MA 02155-1644
Phone (781) 391-5400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240620002702 MA Part A Provider - Skilled Nursing Facility 9830632660 Practice locations: Medford, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053178582. Details of each certification follow.

Skilled nursing facility certification: CCN 225545

Legal name
200 GOVERNORS OPCO LLC
Doing business as
REGALCARE AT COURTYARD
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 10, 1992
Last certification
Mar 11, 2025
Beds
224
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
May 1, 2024
Organization structure
LLCProprietary
Enrollment address
200 Governors Ave
Medford, MA 02155-1644
Nursing home name
REGALCARE AT COURTYARD-MEDFORD
Affiliated entity
REGALCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Regalcare at Courtyard-MedfordCCN 225545 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Feb 10, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
224179.1 residents per day on average
Chain
Regalcare9 facilities in the chain
Special focus status
SFF Candidate
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
2Fines totaling $165,163

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
22D0898799Regalcare at Courtyard200 Governors Avenue, Medford, MA 02155Certificate of waiverMar 12, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Alex Morry Individual Contracted Managing EmployeeAd; May 1, 2024
Saira Nisar Individual Contracted Managing EmployeeMD; May 1, 2024
Eliyahu Mirlis Individual 5% Or Greater Direct Ownership Interest0Wner May 1, 2024 99%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 4

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 3

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": "1709251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1053178582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 GOVERNORS AVE",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021551644",
            "telephone_number": "781-391-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 GOVERNORS AVE",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021551644",
            "telephone_number": "781-391-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "200 GOVERNORS OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-01",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "MIRLIS",
        "authorized_official_first_name": "ELIYAHU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-961-8491"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, MA

Sources for this page

Verify at the official NPI Registry.