Canterbury Mi Opco LLC
Organization Active NPI Skilled Nursing Facility · Waterford, MI
NPI 1114744653 · NPPES record last updated Sep 25, 2024
Key facts
- NPI
- 1114744653
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- CANTERBURY MI OPCO LLC
- Practice address
- 5601 Hatchery Rd
Waterford, MI 48329-3451 - Phone
- (248) 674-9292
- Fax
- (248) 674-5344
- NPI assigned
- Sep 25, 2024
- Organization subpart
- No
Authorized official
- Name
- Jacob Taub
- Title
- Coo
- Phone
- (718) 838-1500
Owners & managing parties with NPI records 1
-
Emily Kathleen Hurst, D.O.
Facilities with the same owner 5
Practitioners 1
-
Fadi Salloum, MD
Affiliated clinicians 2
-
Yahya F Murad, MD
-
Fadi Salloum, MD
Medicare Care Compare: Nursing home
- Listed as
- The Orchards at Canterbury on the Lake
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jul 1, 1994
- Medicare certification status
- Active
- Certified beds
- 128 · 107.8 residents per day on average
- Chain
- The Orchards Michigan
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 2 · fines totaling $45,461
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Skilled nursing facility certification: CCN 235555
- Legal name
- CANTERBURY MI OPCO LLC
- Doing business as
- THE ORCHARDS AT CANTERBURY ON THE LAKE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Jul 1, 1994
- Last certification
- Jul 17, 2024
- Beds
- 128
- Ownership / control type
- Corporation
- Multi-facility organization
- Wellstone
- Organization structure
- LLC · Proprietary
- Enrollment address
- 5601 Hatchery Rd
Waterford, MI 48329-3451 - Nursing home name
- THE ORCHARDS AT CANTERBURY ON THE LAKE
- Affiliated entity
- THE ORCHARDS MICHIGAN
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Emily K Hurst |
Operational/Managerial Control | Dec 3, 2024 | |
| Adp of the SNF | Dec 18, 2024 | ||
| |
Adp of the SNF | Dec 3, 2024 | |
| Isaac Gutman |
5% Or Greater Direct Ownership Interest | Nov 1, 2024 | 40% |
| Adp of the SNF | Dec 3, 2024 | ||
| White Lake Healthcare LLC |
Operational/Managerial Control | Dec 18, 2024 | |
| Adp of the SNF | Dec 18, 2024 | ||
| Jacob Taub |
5% Or Greater Direct Ownership Interest | Nov 1, 2024 | 40% |
| Managing Control - Governing Body |
Nov 1, 2024 | ||
| Adp of the SNF | Dec 3, 2024 | ||
| Alexander Hoffman |
5% Or Greater Direct Ownership Interest | Nov 1, 2024 | 10% |
| Adp of the SNF | Dec 3, 2024 | ||
| Robert Kornfeld |
5% Or Greater Direct Ownership Interest | Nov 1, 2024 | 10% |
| Adp of the SNF | Dec 3, 2024 | ||
| Leigh a McLeod |
Operational/Managerial Control | Dec 3, 2024 | |
| Adp of the SNF | Dec 18, 2024 | ||
| |
Adp of the SNF | Dec 3, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241203001453 | MI | Part a Provider - Skilled Nursing Facility | 6305371147 | Practice locations: Waterford, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
5601 Hatchery Rd
Waterford, MI 48329-3451
Mailing address
5601 Hatchery Rd
Waterford, MI 48329-3451
Phone (248) 674-9292
Other providers in Waterford, MI
- Jaleesa Buyck
- Kate Caddy
- Meghan Callahan
- Canterbury Health Care, Inc
- Canterbury Health Care, Inc
- Canterbury Village Mi Opco LLC
- Jessica Lynn Cantrell
- Hannah Rose Cardinale
- Care More, LLC
- Care Network, LLC
All providers in Waterford, MI · Skilled Nursing Facility in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.