Active NPI
Bellarose Nursing and Rehab Center, Inc.
- Skilled Nursing Facility
- Garner, NC
National Provider Identifier
1093228397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- NH0654
- Legal business name
- BELLAROSE NURSING AND REHAB CENTER, INC.
- Practice address
- 200 Bellarose Lake Way
Garner, NC 27529-7049 - Phone
- (919) 985-8400
- Fax
- (919) 985-8399
- NPI assigned
- Nov 8, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert G Evans
- Title
- President
- Phone
- (919) 985-8400
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NH0654 | NC | Primary |
Addresses
Primary practice location
200 Bellarose Lake Way
Garner, NC 27529-7049
Mailing address
PO Box 469
Garner, NC 27529-0469
Phone (919) 985-8400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180118002600 | NC | Part A Provider - Skilled Nursing Facility | 7012276041 | Practice locations: Garner, NC |
Skilled nursing facility certification: CCN 345574
- Legal name
- BELLAROSE NURSING AND REHAB CENTER INC
- Doing business as
- BELLAROSE NURSING & REHAB
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 29, 2018
- Last certification
- May 16, 2024
- Beds
- 100
- Ownership / control type
- Corporation
- Organization structure
- Corporation
- Incorporated
- Aug 1, 2011 in NC
- Enrollment address
- 200 Bellarose Lake Way
Garner, NC 27529-7049 - Nursing home name
- BELLAROSE NURSING AND REHAB
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Bellarose Nursing And Rehab
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Mar 29, 2018
- Medicare certification status
- Active
- Certified beds
- 100
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2141079 | Bellarose Nursing and Rehab Center, Inc | Certificate of waiver | Dec 6, 2027 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 10
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Robert Gregory Evans | 5% Or Greater Direct Ownership Interest | Aug 1, 2011 | 12.5% |
| Corporate Officer | Aug 1, 2011 | 12.5% | |
| W-2 Managing Employee | Aug 1, 2011 | ||
| Operational/Managerial Control | Aug 1, 2011 | ||
| Rosemary Evans Miller | 5% Or Greater Direct Ownership Interest | Aug 1, 2011 | |
| Debbie Evans Sherrill | 5% Or Greater Direct Ownership Interest | Aug 1, 2011 | 25% |
| Riley Sarkey Evans | 5% Or Greater Direct Ownership Interest | Aug 1, 2011 | 12.5% |
| Corporate Officer | Aug 1, 2011 | 12.5% | |
| Kisa Willis Evans | 5% Or Greater Direct Ownership Interest | Aug 1, 2011 | 12.5% |
| Corporate Officer | Aug 1, 2011 | 12.5% | |
| W-2 Managing Employee | Aug 1, 2011 | ||
| Operational/Managerial Control | Aug 1, 2011 | ||
| Sandra Richardson | W-2 Managing Employee | Nov 17, 2017 | |
| Operational/Managerial Control | Oct 27, 2017 | ||
| Justin Dixon | W-2 Managing Employee | Apr 9, 2018 | |
| Operational/Managerial Control | Apr 9, 2018 | ||
| William Blue Miller | 5% Or Greater Direct Ownership Interest | Aug 1, 2011 | |
| Toni Corey Evans | 5% Or Greater Direct Ownership Interest | Aug 1, 2011 | |
| Corporate Officer | Aug 1, 2011 | 12.5% | |
| William Burroughs | W-2 Managing Employee | Feb 24, 2018 | |
| Operational/Managerial Control | Feb 24, 2018 |
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": "1510099200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1510099200000",
"number": "1093228397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 469",
"city": "GARNER",
"state": "NC",
"postal_code": "275290469",
"telephone_number": "919-985-8400",
"fax_number": "919-985-8399"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 BELLAROSE LAKE WAY",
"city": "GARNER",
"state": "NC",
"postal_code": "275297049",
"telephone_number": "919-985-8400",
"fax_number": "919-985-8399"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BELLAROSE NURSING AND REHAB CENTER, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2017-11-08",
"last_updated": "2017-11-08",
"status": "A",
"authorized_official_last_name": "EVANS",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "G",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "919-985-8400"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NC",
"license": "NH0654",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Garner, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.