Bedrock HCS at Daytona FL LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

BEDROCK HCS AT DAYTONA FL LLC

Practice address

595 N Williamson Blvd
Daytona Beach, FL 32114-7185

Phone

(732) 328-7499

NPI assigned

Apr 1, 2020

Organization subpart

No

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

Authorized official

Name

Esther Tillim

Title

Controller

Phone

(732) 328-7499

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Skilled nursing facility certification: CCN 105570

Legal name

BEDROCK HCS AT DAYTONA FL LLC

Doing business as

INDIGO MANOR

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jul 22, 1987

Last certification

Mar 13, 2025

Beds

173

Ownership / control type

Limited Liability Corporation

Most recent change of ownership

Nov 1, 2021

Organization structure

LLCProprietary

Incorporated

Feb 7, 2020 in FL

Enrollment address

595 N Williamson Blvd
Daytona Beach, FL 32114-7185

Nursing home name

INDIGO MANOR

Affiliated entity

BEDROCK HEALTHCARE

Listed as

Indigo ManorCCN 105570

Overall star rating

2 of 5

Health inspections

1 of 5

Staffing

2 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jul 22, 1987

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

173124.6 residents per day on average

Chain

Bedrock Healthcare9 facilities in the chain

Penalties (3 years)

3Fines totaling $22,530

Processed by Care Compare on Aug 1, 2026.

Tax ID family

Bedrock HCS at Daytona FL LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bedrock HCS at Daytona FL LLC

  • Assisted Living Facility
  • Daytona Beach, FL
  • NPI 1982376133
  NPD tax ID

Networks

• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

All disclosed owners & managing parties 13

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Husam Eddin, M.D

  • Family Medicine Physician
  • Daytona Beach, FL
  • NPI 1629082607

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Husam Eddin, M.D

  • Family Medicine Physician
  • Daytona Beach, FL
  • NPI 1629082607

  Nursing home

  Care Compare affiliation
• Chuni Ginny Kwong, MD

  • Hospitalist Physician
  • Daytona Beach, FL
  • NPI 1215001946

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707264000000",
    "number": "1124656202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "792 VINE AVE BSMT",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015340",
            "telephone_number": "347-598-1029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 N WILLIAMSON BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321147185",
            "telephone_number": "732-328-7499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEDROCK HCS AT DAYTONA FL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-01",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A",
        "authorized_official_last_name": "TILLIM",
        "authorized_official_first_name": "ESTHER",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "732-328-7499"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "NJ",
            "affiliation": "N",
            "address_1": "1776 Avenue Of The States Ste 301",
            "city": "Lakewood",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "087014592",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sta'Cha Beckton, B.S.
• Olga Vladimirovna Beckwith
• Pamela Gail Bedard, MSW
• Brittany Bednov, M.D.
• Eugene Vitaly Bednov, M.D.
• Bedrock HCS at Daytona FL LLC
• Erica Beebe, OTR/L
• Lolade Beecher, DO
• Behavioral Excellence and Skill Training
• Behavioral Health Services of Florida LLC

• Skilled Nursing Facility in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; 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.

Verify at the official NPI Registry.