Organization Active NPI

Ava Springs Opco LLC

  • Skilled Nursing Facility
  • Mercer, PA
National Provider Identifier
1104667120
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
AVA SPRINGS OPCO LLC
Practice address
745 Greenville Rd
Mercer, PA 16137-5070
Phone
(516) 447-5923
NPI assigned
Jun 4, 2024
Last updated
Jun 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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

Authorized official

Name
Gedaliah Wielgus
Title
Authorized Signatory
Phone
(516) 447-5923

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

745 Greenville Rd
Mercer, PA 16137-5070

Mailing address

395 Pearsall Ave Ste K
Cedarhurst, NY 11516-1828
Phone (516) 447-5923

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250507001684 PA Part A Provider - Skilled Nursing Facility 1850818444 Practice locations: Mercer, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104667120. Details of each certification follow.

Skilled nursing facility certification: CCN 396058

Legal name
AVA SPRINGS OPCO LLC
Doing business as
AVALON SPRINGS CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 27, 1998
Last certification
Nov 7, 2024
Beds
100
Ownership / control type
Limited Liability Corporation
Multi-facility organization
WeCare Centers
Organization structure
LLCProprietary
Enrollment address
745 Greenville Road
Mercer, PA 16137-5070
Nursing home name
AVALON SPRINGS CARE CENTER
Affiliated entity
WECARE CENTERS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Avalon Springs Care CenterCCN 396058 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Oct 27, 1998
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10056.4 residents per day on average
Chain
Wecare Centers13 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2329109Avalon Springs Care Ctr745 Greenville Rd, Mercer, PA 16137Certificate of waiverAug 21, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Organization, Lakewood, NJ LLC, Holding company, For-profit Adp of the SNF Mar 1, 2025
KGW Avalon LLC Organization, Woodmere, NY LLC, Holding company, Private equity company Adp of the SNF Mar 1, 2025
Ava Springs Holdco LLC Organization, Cedarhurst, NY LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Mar 1, 2025 100%
Eli Korn Individual 5% Or Greater Indirect Ownership Interest Mar 1, 2025 33%
Pen Med LLC Organization, Hudson, OH LLC, For-profit, Private equity company Adp of the SNF Mar 1, 2025
Gedaliah Wielgus Individual 5% Or Greater Indirect Ownership InterestManaging Member Mar 1, 2025 33%
Operational/Managerial Control Mar 1, 2025
Managing Control - Governing BodyManaging Member of Applicant Mar 1, 2025
Adp of the SNF Mar 1, 2025
Scott David Morgan Individual Operational/Managerial Control Mar 1, 2025
Managing Control - Governing BodyMedical Director Mar 1, 2025
Adp of the SNF Mar 1, 2025
Wecare HCC LLC Organization, Cedarhurst, NY LLC, Management services company, Consulting firm, For-profit Operational/Managerial Control Mar 1, 2025
Adp of the SNF Mar 1, 2025
Asp Prop 3 LLC Organization, Lakewood, NJ LLC, For-profit Adp of the SNF Mar 1, 2025
Organization, Lakewood, NJ LLC, Holding company Adp of the SNF Mar 1, 2025
Legacy 360 Holdings LLC Organization, Lakewood, NJ For-profit Adp of the SNF Mar 1, 2025
Pa1Prop 1 LLC Organization, Lakewood, NJ LLC, For-profit Adp of the SNF Mar 1, 2025
Aryeh Grinspan Individual 5% Or Greater Indirect Ownership InterestOwner Mar 1, 2025 34%
Operational/Managerial Control Mar 1, 2025
Managing Control - Governing BodyOwner Mar 1, 2025
Adp of the SNF Mar 1, 2025
Schwartz Family Dynasty Trust Organization, Anchorage, AK For-profit Adp of the SNF Mar 1, 2025
Ellen Perry Individual Operational/Managerial Control Mar 1, 2025
Managing Control - Governing BodyAdministrator Mar 1, 2025
Adp of the SNF Mar 1, 2025
3SSS 3 Holdings LLC Organization, Lakewood, NJ LLC, Holding company, For-profit, Private equity company Adp of the SNF Mar 1, 2025

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 9

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

Practitioners & affiliated clinicians

Practitioners 1

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 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": "1717459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717459200000",
    "number": "1104667120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 PEARSALL AVE STE K",
            "city": "CEDARHURST",
            "state": "NY",
            "postal_code": "115161828",
            "telephone_number": "516-447-5923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 GREENVILLE RD",
            "city": "MERCER",
            "state": "PA",
            "postal_code": "161375070",
            "telephone_number": "516-447-5923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVA SPRINGS OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-04",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A",
        "authorized_official_last_name": "WIELGUS",
        "authorized_official_first_name": "GEDALIAH",
        "authorized_official_title_or_position": "AUTHORIZED SIGNATORY",
        "authorized_official_telephone_number": "516-447-5923"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mercer, PA

Sources for this page

Verify at the official NPI Registry.