Active NPI
Fort Valley Operator LLC
- Skilled Nursing Facility
- Fort Valley, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 1-111-1073
- Legal business name
- FORT VALLEY OPERATOR LLC
- Practice address
- 604 Bluebird Blvd
Fort Valley, GA 31030-5081 - Phone
- (478) 825-2031
- Fax
- (478) 825-2041
- NPI assigned
- Mar 27, 2008
- 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
- Michelle Delker
- Title
- Cfo
- Phone
- (813) 321-1239
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 1-111-1073 | GA | Primary |
Addresses
Primary practice location
604 Bluebird Blvd
Fort Valley, GA 31030-5081
Mailing address
604 Bluebird Blvd
Fort Valley, GA 31030-5081
Phone (478) 825-2031
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000141028A | Medicaid | GA |
Other names 1
- Fort Valley Health and Rehab
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080529000312 | GA | Part A Provider - Skilled Nursing Facility | 3375613680 | Practice locations: Fort Valley, GA |
Skilled nursing facility certification: CCN 115651
- Legal name
- FORT VALLEY OPERATOR LLC
- Doing business as
- FORT VALLEY HEALTH AND REHAB
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 1, 1998
- Last certification
- Aug 18, 2024
- Beds
- 75
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- MISSOIN HEALTHCARE ORGANIZATION
- Organization structure
- LLC
- Incorporated
- Mar 4, 2008 in FL
- Enrollment address
- 604 Bluebird Blvd
Fort Valley, GA 31030-5081 - Nursing home name
- FORT VALLEY CROSSING OF JOURNEY LLC
- Affiliated entity
- JOURNEY HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Fort Valley Crossing of Journey LLC
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jul 1, 1998
- Medicare certification status
- Active
- Certified beds
- 75
- Chain
- Journey Healthcare
National Provider Directory
National Provider Directory- Tax ID family
- Brentwood Nursing LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Skilled Nursing Facility
- Fort Valley, GA
- NPI 1376604082
Ownership & related parties
All disclosed owners & managing parties 11
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 |
|---|---|---|---|
| Stuart D Lindeman | 5% Or Greater Indirect Ownership Interest | Jan 1, 2015 | 5% |
| Corporate Officer | Jan 1, 2015 | 100% | |
| Jamie Yoakum | Corporate Officer | Mar 14, 2024 | |
| Michelle Barnes | Operational/Managerial Control | Dec 1, 2018 | |
| Barres, LLC | 5% Or Greater Indirect Ownership Interest | Jan 1, 2015 | 5% |
| GBD LLC | 5% Or Greater Direct Ownership Interest | Mar 4, 2008 | 5% |
| Operational/Managerial Control | Jan 1, 2015 | ||
| Joseph M Passero | 5% Or Greater Indirect Ownership Interest | Jan 1, 2015 | 5% |
| Scott N Feuer | 5% Or Greater Indirect Ownership Interest | Jan 1, 2015 | 45% |
| Mission Health of Georgia, LLC | 5% Or Greater Direct Ownership Interest | Jan 1, 2015 | 5% |
| Operational/Managerial Control | Jan 1, 2015 | ||
| T and C Capital Assets, LLC | 5% Or Greater Indirect Ownership Interest | Jan 1, 2015 | 5% |
| Bryan L Crino | 5% Or Greater Indirect Ownership Interest | Jan 1, 2015 | 45% |
| Windward Health Partners LLC | 5% Or Greater Indirect Ownership Interest | Jan 1, 2015 | 80% |
Facilities with the same owner 38
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Skilled Nursing Facility
- Bainbridge, GA
- NPI 1508038696
Barres, LLC, GBD LLC, Mission Health of Georgia, LLC, T and C Capital Assets, LLC, Windward Health Partners LLC
-
- Skilled Nursing Facility
- Fort Gaines, GA
- NPI 1750553996
Barres, LLC, GBD LLC, Mission Health of Georgia, LLC, T and C Capital Assets, LLC, Windward Health Partners LLC
-
- Skilled Nursing Facility
- Jesup, GA
- NPI 1952573040
Barres, LLC, GBD LLC, Mission Health of Georgia, LLC, T and C Capital Assets, LLC, Windward Health Partners LLC
-
- Skilled Nursing Facility
- Tucker, GA
- NPI 1508038753
Barres, LLC, GBD LLC, Mission Health of Georgia, LLC, Windward Health Partners LLC
-
- Skilled Nursing Facility
- Roberta, GA
- NPI 1770755951
Barres, LLC, GBD LLC, Mission Health of Georgia, LLC, T and C Capital Assets, LLC, Windward Health Partners LLC
-
- Skilled Nursing Facility
- Twin City, GA
- NPI 1588836738
Barres, LLC, GBD LLC, Mission Health of Georgia, LLC, T and C Capital Assets, LLC, Windward Health Partners LLC
-
- Skilled Nursing Facility
- Arma, KS
- NPI 1144525031
Barres, LLC, T and C Capital Assets, LLC, Windward Health Partners LLC
-
- Skilled Nursing Facility
- Cottonwood Falls, KS
- NPI 1639728686
Barres, LLC, T and C Capital Assets, LLC, Windward Health Partners LLC
-
- Skilled Nursing Facility
- Colby, KS
- NPI 1285824797
Barres, LLC, T and C Capital Assets, LLC, Windward Health Partners LLC
-
- Skilled Nursing Facility
- Columbus, WI
- NPI 1750376489
Barres, LLC, T and C Capital Assets, LLC, Windward Health Partners LLC
-
- Skilled Nursing Facility
- Dickson, TN
- NPI 1215109459
Barres, LLC, GBD LLC, Mission Health of Georgia, LLC, T and C Capital Assets, LLC, Windward Health Partners LLC
-
- Skilled Nursing Facility
- Downs, KS
- NPI 1619526662
Barres, LLC, T and C Capital Assets, LLC, Windward Health Partners LLC
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Unadilla, GA
- NPI 1154615979
-
- Surgery Physician
- Colquitt, GA
- NPI 1750324026
-
- Emergency Medicine Physician
- Smyrna, GA
- NPI 1295960581
Affiliated clinicians 2
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Family Medicine Physician
- Unadilla, GA
- NPI 1154615979
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206576000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1642377600000",
"number": "1093987232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "604 BLUEBIRD BLVD",
"city": "FORT VALLEY",
"state": "GA",
"postal_code": "310305081",
"telephone_number": "478-825-2031",
"fax_number": "478-825-2041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "604 BLUEBIRD BLVD",
"city": "FORT VALLEY",
"state": "GA",
"postal_code": "310305081",
"telephone_number": "478-825-2031",
"fax_number": "478-825-2041"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FORT VALLEY OPERATOR LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-03-27",
"last_updated": "2022-01-17",
"certification_date": "2022-01-17",
"status": "A",
"authorized_official_last_name": "DELKER",
"authorized_official_first_name": "MICHELLE",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "813-321-1239"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "GA",
"license": "1-111-1073",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000141028A",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Fort Valley Health and Rehab",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Fort Valley Health and Rehab",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fort Valley, GA
- Fort Valley Crossing of Journey LLC
- Fort Valley Dialysis Center LLC
- Fort Valley Drug Company LLC.
- Fort Valley Drug Company LLC. LTC
- Fort Valley Family Chiropractic, LLC
- Fort Valley State University
- Fruit of the Spirit Companion Services
- Fruit of the Spirit Companion Services
- Ft Valley Chiropractic Clinic PC
- Dennis Wayne Garrett Jr.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2022; 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.