2990 Holme Operating, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

2990 HOLME OPERATING, LLC

Doing business as

Immaculate Mary Center for Rehabilitation & Healthcare

Practice address

2990 Holme Ave
Philadelphia, PA 19136-1830

Phone

(215) 335-2100

NPI assigned

Jul 30, 2014

Last updated

Jul 30, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Charles-Edouard Gros

Title

Manager

Phone

(718) 360-8083

Specialties & licenses 1

Addresses

Other names 1

• Immaculate Mary Center for Rehabilitation & Healthcare Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134537426. Details of each certification follow.

• CCN 395338 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 395338

Legal name

2990 HOLME OPERATING LLC

Doing business as

IMMACULATE MARY CENTER FOR REHABILITATION & HEALTHCARE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Mar 18, 1976

Last certification

Apr 17, 2025

Beds

296

Ownership / control type

Corporation

Organization structure

LLCProprietary

Incorporated

May 7, 2014 in PA

Enrollment address

2990 Holme Avenue
Immaculate Mary Center for Rehabilitation & Health
Philadelphia, PA 16136-1830

Nursing home name

IMMACULATEMARYCENTER FOR REHABILITATION&HEALTHCARE

Affiliated entity

CENTER MANAGEMENT GROUP

Listed as

Immaculatemarycenter for Rehabilitation&HealthcareCCN 395338 · All quality measures

Overall star rating

1 of 5

Health inspections

2 of 5

Staffing

1 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Mar 18, 1976

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

296281.3 residents per day on average

Chain

Center Management Group16 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Tax ID family

2990 Holme Operating 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.

• Immaculate Mary Home

  • Skilled Nursing Facility
  • Philadelphia, PA
  • NPI 1205810587
  NPD tax ID

Locations

All disclosed owners & managing parties 21

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 2

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

• Brian B Kimmel, DO

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1528007176

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Larry Wayne Spector, D.O.

  • Internal Medicine Physician
  • Elkins Park, PA
  • NPI 1780613398

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 4

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.

• Zafar Ali Khan, M.D.

  • Internal Medicine Physician
  • Levittown, PA
  • NPI 1306885025
  NPD (past)
• Brian B Kimmel, DO

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1528007176
  NPD (past)
• Cameron Moore, MD

  • Family Medicine Physician
  • Norristown, PA
  • NPI 1962932897
  NPD (past)
• Larry Wayne Spector, D.O.

  • Internal Medicine Physician
  • Elkins Park, PA
  • NPI 1780613398
  NPD (past)

Affiliated clinicians 3

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

• Brian B Kimmel, DO

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1528007176

  Nursing home

  Care Compare affiliation
• Cameron Moore, MD

  • Family Medicine Physician
  • Norristown, PA
  • NPI 1962932897

  Nursing home

  Care Compare affiliation
• Larry Wayne Spector, D.O.

  • Internal Medicine Physician
  • Elkins Park, PA
  • NPI 1780613398

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1406678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406678400000",
    "number": "1134537426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 LANSDALE AVE",
            "city": "LANSDALE",
            "state": "PA",
            "postal_code": "194462958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 HOLME AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191361830",
            "telephone_number": "215-335-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "2990 HOLME OPERATING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-30",
        "last_updated": "2014-07-30",
        "status": "A",
        "authorized_official_last_name": "GROS",
        "authorized_official_first_name": "CHARLES-EDOUARD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "718-360-8083",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Immaculate Mary Center for Rehabilitation & Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Skilled Nursing Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2014; 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.