NPIMap

Organization Active NPI

Davenport Opco LLC

  • Skilled Nursing Facility
  • Davenport, FL
National Provider Identifier
1093591869
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
DAVENPORT OPCO LLC
Practice address
206 W Orange St
Davenport, FL 33837-3118
Phone
(718) 916-1443
NPI assigned
Sep 6, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

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

Authorized official

Name
Joe Neuman
Title
Authorized Member
Phone
(718) 916-1443

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

206 W Orange St
Davenport, FL 33837-3118

Mailing address

144 Shady Lane Dr
Lakewood, NJ 08701-2351
Phone (732) 364-2444

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240102001929 FL Part A Provider - Skilled Nursing Facility 7315397460 Practice locations: Davenport, FL

Skilled nursing facility certification: CCN 105777

Legal name
DAVENPORT OPCO LLC
Doing business as
DAVENPORT NURSING AND REHAB CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jun 26, 1992
Last certification
Oct 4, 2023
Beds
60
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Vered
Organization structure
LLCProprietary
Incorporated
Jul 28, 2023 in DE
Enrollment address
206 W Orange St
Davenport, FL 33837-3118
Nursing home name
DAVENPORT NURSING AND REHAB CENTER
Affiliated entity
ELIYAHU MIRLIS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Davenport Nursing and Rehab CenterCCN 105777
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 26, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6055.4 residents per day on average
Chain
Eliyahu Mirlis13 facilities in the chain
Penalties (3 years)
1Fines totaling $8,172

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Catherine Valentino-Keesling Individual Operational/Managerial Control Jan 9, 2025
Managing Control - Governing BodyAdministrator Sep 1, 2023
Adp of the SNF Jan 9, 2025
Sarah Becher Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2023 1%
Melanie M Albors-Mora Individual Operational/Managerial Control Jan 9, 2025
Managing Control - Governing BodyMedical Director Sep 1, 2023
Adp of the SNF Jan 9, 2025
206 W Orange St Davenport Holdco LLC Organization, Lakewood, NJ Created for acquisition, LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Sep 1, 2023 100%
VRD 10 Hldco LLC Organization, Lakewood, NJ LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Sep 1, 2023 100%
Eliyahu Mirlis Individual 5% Or Greater Indirect Ownership InterestManager Sep 1, 2023 99%

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 4

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

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": "1693958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1093591869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 SHADY LANE DR",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087012351",
            "telephone_number": "732-364-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 W ORANGE ST",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338373118",
            "telephone_number": "718-916-1443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVENPORT OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-06",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "NEUMAN",
        "authorized_official_first_name": "JOE",
        "authorized_official_title_or_position": "AUTHORIZED MEMBER",
        "authorized_official_telephone_number": "718-916-1443"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, FL

Sources for this page

Verify at the official NPI Registry.