200 South Ritchie Avenue Operations LLC
Organization Active NPI Skilled Nursing Facility · Ravenswood, WV
NPI 1124202304 · NPPES record last updated May 2, 2016
Key facts
- NPI
- 1124202304
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 122 (WV)
- Legal business name
- 200 SOUTH RITCHIE AVENUE OPERATIONS LLC
- Practice address
- 200 S Ritchie Ave
Ravenswood, WV 26164-1721 - Phone
- (304) 273-9385
- Fax
- (304) 273-9387
- NPI assigned
- Dec 24, 2007
- Organization subpart
- No
Authorized official
- Name
- Michael T. Berg
- Title
- Assistant Secretary
- Phone
- (505) 468-4752
Owners & managing parties with NPI records 1
-
Arif M Malik, MD
Facilities with the same owner 178
Practitioners 1
-
Arif M Malik, MD
Affiliated clinicians 2
-
Arif M Malik, MD
Medicare Care Compare: Nursing home
- Listed as
- Ravenswood Village
- Overall star rating
- ★★★★☆ 4 of 5
- Health inspections
- ★★★★☆ 4 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jan 1, 2002
- Medicare certification status
- Active
- Certified beds
- 62 · 60.4 residents per day on average
- Chain
- Genesis Healthcare
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
Skilled nursing facility certification: CCN 515177
- Legal name
- 200 SOUTH RITCHIE AVENUE OPERATIONS LLC
- Doing business as
- RAVENSWOOD VILLAGE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 2002
- Last certification
- Mar 26, 2025
- Beds
- 62
- Ownership / control type
- Corporation
- Multi-facility organization
- Genesis Healthcare
- Most recent change of ownership
- Apr 1, 2011
- Organization structure
- LLC · Proprietary
- Incorporated
- Aug 16, 2007 in WV
- Enrollment address
- 200 S Ritchie Ave
Ravenswood, WV 26164-1721 - Nursing home name
- RAVENSWOOD VILLAGE
- Affiliated entity
- GENESIS HEALTHCARE
All disclosed owners & managing parties 22
| Name | Role | Since | Share |
|---|---|---|---|
| Laura Bridgeford |
Corporate Officer |
Jun 1, 2024 | 100% |
| HCCF Management Group XI LLC |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 10.8% |
| Gen Operations I LLC |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| Gen Operations II LLC |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| FC-Gen Operations Investment LLC |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| |
Adp of the SNF | Mar 3, 2025 | |
| |
Adp of the SNF | Mar 3, 2025 | |
| Sundance Rehabilitation Holdco Inc |
5% Or Greater Indirect Ownership Interest | Jan 1, 2016 | 5.81% |
| Genesis Healthcare LLC |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| Sun Healthcare Group Inc |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 52.24% |
| Tanatha Amos |
Operational/Managerial Control | Jun 1, 2024 | |
| Adp of the SNF | Mar 3, 2025 | ||
| Welltower Op, LLC |
5% Or Greater Indirect Ownership Interest | Mar 1, 2024 | 5.4% |
| Arnold M Whitman |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 10.8% |
| Arif M Malik |
Operational/Managerial Control | Jul 1, 2024 | |
| Adp of the SNF | Mar 3, 2025 | ||
| Genesis Healthcare Inc |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 52.24% |
| Zac Properties XI LLC |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 7.6% |
| Steven E Fishman |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 7.6% |
| Avi Pinchas Mendelson |
Corporate Officer |
Jun 1, 2024 | 100% |
| Michael T Berg |
Corporate Officer |
Mar 2, 2015 | 100% |
| Genesis Operations V LLC |
5% Or Greater Direct Ownership Interest | Feb 2, 2015 | 100% |
| GHC Holdings LLC |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| Genesis Holdings LLC |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080411000362 | WV | Part a Provider - Skilled Nursing Facility | 7214014455 | Practice locations: Ravenswood, WV |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 122 | WV | Yes |
Addresses
Primary practice location
200 S Ritchie Ave
Ravenswood, WV 26164-1721
Mailing address
101 E State St
Kennett Square, PA 19348-3109
Phone (610) 925-4436
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0002860000 | Medicaid | WV |
Other names
- Ravenswood Village
Other providers in Ravenswood, WV
- Adrienne Virginia Acord
- Activate Healthcare - Constellium
- Brandon Clark Adams
- Cassie Adkins
- Chloe Marie Allen
All providers in Ravenswood, WV · Skilled Nursing Facility in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 2016. 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.