Shippenville PA Opco LLC
Organization Active NPI Skilled Nursing Facility · Shippenville, PA
NPI 1083467294 · NPPES record last updated Apr 8, 2024
Key facts
- NPI
- 1083467294
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- SHIPPENVILLE PA OPCO LLC
- Practice address
- 21158 Paint Blvd
Shippenville, PA 16254-4024 - Phone
- (814) 226-5660
- NPI assigned
- Apr 8, 2024
- Organization subpart
- No
Authorized official
- Name
- Mr. Aharon Franco
- Title
- Authorized Representative
- Phone
- (646) 823-6464
Owners & managing parties with NPI records 1
-
Susen A Rossino, MD
Facilities with the same owner 11
Practitioners 3
-
Randy M Kreider, MD
-
Brandon M Roscoe, M.D.
-
Susen A Rossino, MD
Affiliated clinicians 2
-
Randy M Kreider, MD
-
Susen A Rossino, MD
Medicare Care Compare: Nursing home
- Listed as
- Shippenville Nursing and Rehab
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★☆☆☆ 2 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Nov 7, 1983
- Medicare certification status
- Active
- Certified beds
- 120 · 96.3 residents per day on average
- Chain
- Valley West Health
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D0183336 | Shippenville Nursing & Rehab | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Skilled nursing facility certification: CCN 395607
- Legal name
- SHIPPENVILLE PA OPCO LLC
- Doing business as
- SHIPPENVILLE NURSING AND REHAB
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 7, 1983
- Last certification
- Jun 13, 2025
- Beds
- 120
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC · Proprietary
- Enrollment address
- 21158 Paint Blvd
Shippenville, PA 16254-4024 - Nursing home name
- SHIPPENVILLE NURSING AND REHAB
- Affiliated entity
- VALLEY WEST HEALTH
All disclosed owners & managing parties 28
| Name | Role | Since | Share |
|---|---|---|---|
| Valley West Health LLC |
Operational/Managerial Control | Jan 24, 2025 | |
| Adp of the SNF | Dec 17, 2024 | ||
| Fillmore Strategic Investors LLC |
Adp of the SNF | Dec 17, 2024 | |
| Barbara Hicks |
Adp of the SNF | Dec 17, 2024 | |
| Susen a Rossino |
Adp of the SNF | Dec 17, 2024 | |
| Washington State Investment Board |
Adp of the SNF | Dec 17, 2024 | |
| Melissa Polito |
Adp of the SNF | Dec 17, 2024 | |
| Isaac Rami |
Operational/Managerial Control | Jan 24, 2025 | |
| Adp of the SNF | Jan 24, 2025 | ||
| Surety Compliance |
Adp of the SNF | Jan 24, 2025 | |
| Iskeb 2024 Trust |
5% Or Greater Indirect Ownership Interest | Oct 29, 2024 | 95% |
| Adp of the SNF | Jan 24, 2025 | ||
| Heather Andrews |
Adp of the SNF | Jan 24, 2025 | |
| Drumm Merger Co |
Adp of the SNF | Dec 17, 2024 | |
| Holly a Rasmussen-Jones |
Adp of the SNF | Jan 24, 2025 | |
| Pearl Senior Care, LLC. |
Adp of the SNF | Dec 17, 2024 | |
| Drumm Intermediary Sub Co LLC |
Adp of the SNF | Dec 17, 2024 | |
| Iskeb Western PA LLC |
5% Or Greater Indirect Ownership Interest | Oct 29, 2024 | 95% |
| Adp of the SNF | Dec 17, 2024 | ||
| Beverly Enterprises LLC |
Adp of the SNF | Dec 17, 2024 | |
| Drumm Merger Co Sub LLC |
Adp of the SNF | Dec 17, 2024 | |
| Beverly Enterprises - Pennsylvania, Inc. |
Adp of the SNF | Dec 17, 2024 | |
| Beverly Health and Rehabilitiation Services, Inc |
Adp of the SNF | Dec 17, 2024 | |
| Geary Property Holdings LLC |
Adp of the SNF | Dec 17, 2024 | |
| Kim Linam |
Adp of the SNF | Jan 24, 2025 | |
| Aharon Franco |
5% Or Greater Indirect Ownership Interest | Oct 29, 2024 | 5% |
| Operational/Managerial Control | Jan 24, 2025 | ||
| Adp of the SNF | Jan 24, 2025 | ||
| Jean Miller |
Adp of the SNF | Jan 24, 2025 | |
| Keystone Ventures LLC |
5% Or Greater Indirect Ownership Interest | Oct 29, 2024 | 5% |
| Adp of the SNF | Dec 17, 2024 | ||
| GPH Shippenville LP |
Adp of the SNF | Dec 17, 2024 | |
| Western PA Opco Holdings I LLC |
5% Or Greater Direct Ownership Interest | Oct 29, 2024 | 100% |
| Adp of the SNF | Dec 17, 2024 | ||
| Sarah Karity |
5% Or Greater Indirect Ownership Interest | Oct 29, 2024 | 95% |
| Adp of the SNF | Jan 24, 2025 | ||
| Nicholas R Finn |
Adp of the SNF | Jan 24, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241217003459 | PA | Part a Provider - Skilled Nursing Facility | 8527595404 | Practice locations: Shippenville, PA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
21158 Paint Blvd
Shippenville, PA 16254-4024
Mailing address
1815 Lakewood Road
Suite 255
Toms River, NJ 08755
Other names
- Shippenville Nursing and Rehab
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All providers in Shippenville, PA · Skilled Nursing Facility in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2024. 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.