NPIMap

Organization Active NPI

Monticello Ky Opco LLC

Doing business as Mountain Ridge Health and Rehabilitation

  • Skilled Nursing Facility
  • Monticello, KY
National Provider Identifier
1104664705
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MONTICELLO KY OPCO LLC
Doing business as
Mountain Ridge Health and Rehabilitation
Practice address
1901 Ky-90
Monticello, KY 42633
Phone
(606) 348-6034
NPI assigned
Jul 17, 2024
Last updated
Jul 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Authorized official

Name
Ms. Samantha Rae Cogar
Title
Executive Assistant
Phone
(502) 667-8150

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1901 Ky-90
Monticello, KY 42633

Mailing address

1901 Ky-90
Monticello, KY 42633
Phone (502) 667-8150

Other names 1

  • Mountain Ridge Health and Rehabilitation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241115004153 KY Part A Provider - Skilled Nursing Facility 4183158892 Practice locations: Monticello, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104664705. Details of each certification follow.

Skilled nursing facility certification: CCN 185298

Legal name
MONTICELLO KY OPCO LLC
Doing business as
MOUNTAIN RIDGE HEALTH AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 1, 1991
Last certification
Sep 6, 2024
Beds
59
Ownership / control type
Corporation
Multi-facility organization
Clearview Healthcare Management
Most recent change of ownership
Aug 1, 2024
Organization structure
LLCProprietary
Enrollment address
1901 W Highway 90
Monticello, KY 42633-2460
Nursing home name
MOUNTAIN RIDGE HEALTH AND REHABILITATION
Affiliated entity
SIMCHA HYMAN & NAFTALI ZANZIPER

Care Compare: Nursing home

Medicare Care Compare
Listed as
Mountain Ridge Health and RehabilitationCCN 185298 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
2 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Dec 1, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5956.0 residents per day on average
Chain
Simcha Hyman & Naftali Zanziper79 facilities in the chain
Penalties (3 years)
3Fines totaling $13,426

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

1901 W Highway 90
Monticello, KY 42633
Phone (606) 348-6034

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Barbara Grooms Individual Operational/Managerial Control Aug 1, 2024
Adp of the SNF Aug 1, 2024
Monticello Ky Opco Holdco LLC Organization, Louisville, KY Created for acquisition, LLC, Holding company 5% Or Greater Direct Ownership Interest Aug 1, 2024 100%
Laura L Faughn Individual Adp of the SNF Aug 1, 2024
Mick Vujanovic Individual 5% Or Greater Indirect Ownership Interest Aug 1, 2024 50%
Samantha Cogar Individual Operational/Managerial Control Aug 1, 2024
Adp of the SNF Aug 1, 2024
Jessica Lynn Metcalf Individual Operational/Managerial Control Mar 24, 2025
Adp of the SNF Mar 24, 2025
Sweet Home Management LLC Organization, Louisville, KY Management services company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 1, 2024 100%
Claire Vujanovic Individual 5% Or Greater Indirect Ownership Interest Aug 1, 2024 50%

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 27

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

View all 27

Practitioners & affiliated clinicians

Practitioners 3

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 2

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": "1721174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1104664705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 KY-90",
            "city": "MONTICELLO",
            "state": "KY",
            "postal_code": "42633",
            "telephone_number": "502-667-8150",
            "fax_number": "502-467-8720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 KY-90",
            "city": "MONTICELLO",
            "state": "KY",
            "postal_code": "42633",
            "telephone_number": "606-348-6034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTICELLO KY OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-17",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-10",
        "status": "A",
        "authorized_official_last_name": "COGAR",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "502-667-8150",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Ridge Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monticello, KY

Sources for this page

Verify at the official NPI Registry.