Active NPI
John Knox Village of Central Florida, Inc
Doing business as Majestic Oaks
- Skilled Nursing Facility
- Orange City, FL
National Provider Identifier
1124011770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- SNF12590961
- Legal business name
- JOHN KNOX VILLAGE OF CENTRAL FLORIDA, INC
- Doing business as
- Majestic Oaks
- Practice address
- 901 Veterans Memorial Parkway
Orange City, FL 32763-6167 - Phone
- (386) 775-3840
- Fax
- (386) 775-0456
- NPI assigned
- Aug 30, 2005
- Last updated
- Sep 22, 2016
- 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
- Joseph Trainor
- Title
- Executive Director
- Phone
- (386) 775-3840
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | HHA20602096 | FL | |
| Assisted Living Facility | 310400000X | AL5177 | FL | |
| Skilled Nursing Facility | 314000000X | SNF12590961 | FL | Primary |
Addresses
Primary practice location
901 Veterans Memorial Parkway
Orange City, FL 32763-6167
Mailing address
101 Northlake Dr
Orange City, FL 32763-6167
Phone (386) 775-3840
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 026900000 | Medicaid | FL |
Other names 1
- Majestic Oaks
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 3
NPI to CCN mapping 2
The Medicare certification numbers (CCNs) connected to NPI 1124011770. Details of each certification follow.
Home health agency certification: CCN 107530
- Legal name
- JOHN KNOX VILLAGE OF CENTRAL FLORIDA INC.
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- May 16, 1996
- Last certification
- Feb 5, 2020
- Ownership / control type
- Non-Profit
- Organization structure
- Corporation
- Enrollment address
- 101 Northlake Dr
Orange City, FL 32763-6167
Skilled nursing facility certification: CCN 105374
- Legal name
- JOHN KNOX VILLAGE OF CENTRAL FLORIDA INC.
- Doing business as
- MAJESTIC OAKS
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Sep 19, 1980
- Last certification
- Dec 12, 2024
- Beds
- 150
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation
- Incorporated
- May 25, 1978 in FL
- Enrollment address
- 901 Veterans Memorial Pkwy
Orange City, FL 32763-6200 - Nursing home name
- MAJESTIC OAKS
Other NPIs with the same Medicare PAC ID 3
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Oak Park LTC Pharmacy
- Long Term Care Pharmacy
- Orange City, FL
- NPI 1386033736
4284785205
-
- Home Health Agency
- Orange City, FL
- NPI 1346584828
4284785205
-
- Primary Care Nurse Practitioner
- Orange City, FL
- NPI 1861263147
4284785205
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Home Health Agency
- Orange City, FL
- NPI 1346584828
O20090701000605
Care Compare: Home health agency
Medicare Care Compare- Listed as
- John Knox Village of Central Florida Inc
- Overall star rating
- Ownership
- Non-Profit
- Certified
- May 16, 1996
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Majestic Oaks
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Sep 19, 1980
- Medicare certification status
- Active
- Certified beds
- 150
National Provider Directory
National Provider DirectoryLocations
901 Veterans Memorial Pkwy
Orange City, FL 32763
Phone (386) 775-2008
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Ownership & related parties
All disclosed owners & managing parties 12
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 |
|---|---|---|---|
| Elliott Wimberly | Managing Control - Governing Body | May 21, 2025 | |
| Joe Trainor | Operational/Managerial Control | Feb 2, 2015 | 100% |
| Adp of the SNF | Feb 2, 2015 | ||
| Corporate Officer | Oct 27, 2015 | ||
| Operational/Managerial Control | Oct 27, 2015 | ||
| Michael Buxton | Operational/Managerial Control | Jul 8, 2022 | |
| Adp of the SNF | Jul 8, 2022 | ||
| Paula Kelton | Managing Control - Governing Body | Jan 1, 2025 | |
| Adp of the SNF | Sep 30, 2020 | ||
| Cynthia Pohl | Operational/Managerial Control | Feb 21, 2022 | |
| Adp of the SNF | Feb 21, 2022 | ||
| Corporate Officer | Feb 21, 2022 | ||
| W-2 Managing Employee | Feb 21, 2022 | ||
| William Oconnor | Managing Control - Governing Body | Jan 1, 2025 | |
| Adp of the SNF | Apr 1, 2024 | ||
| Bruce Smith | Managing Control - Governing Body | Jan 1, 2025 | |
| Gary Wright | Managing Control - Governing Body | Jan 1, 2025 | |
| John Knox Village of Central Florida Inc. | 5% Or Greater Direct Ownership Interest | May 16, 1996 | 100% |
| Operational/Managerial Control | Jan 1, 2015 | ||
| Nicole Vega | W-2 Managing Employee | Dec 31, 2021 |
Owners & managing parties with NPI records 3
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
dba Oak Park LTC Pharmacy
- Long Term Care Pharmacy
- Orange City, FL
- NPI 1386033736
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
- Home Health Agency
- Orange City, FL
- NPI 1346584828
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
- Primary Care Nurse Practitioner
- Orange City, FL
- NPI 1861263147
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| John Knox Village of Central Florida Inc. | Home health agency | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
May 16, 1996 Jan 1, 2015 |
Owned or controlled facilities with NPI records 1
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- Home Health Agency
- Orange City, FL
- NPI 1346584828
5% Or Greater Direct Ownership Interest, Operational/Managerial 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.
-
- Adult Health Nurse Practitioner
- Orange City, FL
- NPI 1972690972
Affiliated clinicians 10
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Hospice and Palliative Medicine (Internal Medicine) Physician
- Daytona Beach, FL
- NPI 1750304945
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125360000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1474502400000",
"number": "1124011770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 NORTHLAKE DR",
"city": "ORANGE CITY",
"state": "FL",
"postal_code": "327636167",
"telephone_number": "386-775-3840",
"fax_number": "386-775-0456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 VETERANS MEMORIAL PARKWAY",
"city": "ORANGE CITY",
"state": "FL",
"postal_code": "327636167",
"telephone_number": "386-775-3840",
"fax_number": "386-775-0456"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JOHN KNOX VILLAGE OF CENTRAL FLORIDA, INC",
"organizational_subpart": "NO",
"enumeration_date": "2005-08-30",
"last_updated": "2016-09-22",
"status": "A",
"authorized_official_last_name": "TRAINOR",
"authorized_official_first_name": "JOSEPH",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "386-775-3840"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "FL",
"license": "HHA20602096",
"primary": false
},
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "FL",
"license": "AL5177",
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "FL",
"license": "SNF12590961",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "026900000",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Majestic Oaks",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Orange City, FL
- Jessup, Inc
- Jose Alberto Jimenez
- James M Jochum, MD
- John Knox Village of Central Florida Inc (Oak Park LTC Pharmacy)
- John Knox Village of Central Florida Inc (Oak Park Pharmacy)
- John Knox Village of Central Florida, Inc
- John Knox Village of Central Florida, Inc
- Heather Johns
- Caleigh Johnson
- Melissa Johnson
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2016; 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.