Princeton Ky Opco LLC
Organization Active NPI Skilled Nursing Facility · Princeton, KY
NPI 1164072682 · NPPES record last updated Oct 9, 2024
Key facts
- NPI
- 1164072682
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- PRINCETON KY OPCO LLC
- Practice address
- 1333 W Main St
Princeton, KY 42445-6211 - Phone
- (270) 365-3541
- NPI assigned
- Sep 17, 2019
- Organization subpart
- No
Authorized official
- Name
- Mick Vujanovic
- Title
- Ceo
- Phone
- (502) 667-8150
Facilities with the same owner 67
Practitioners 4
-
David Wayne French, M.D.
-
Manoj H Majmudar, MD
-
Debra L. Wilder, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Skilled nursing facility certification: CCN 185316A
- Legal name
- PRINCETON KY OPCO LLC
- Doing business as
- PRINCETON NURSING & REHABILITATION
- Organization structure
- LLC · Proprietary
- Incorporated
- Aug 20, 2019 in KY
- Enrollment address
- 1333 W Main St
Princeton, KY 42445-6211 - Nursing home name
- PRINCETON NURSING & REHABILITATION
- Affiliated entity
- SIMCHA HYMAN & NAFTALI ZANZIPER
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| SHNZ Holdings LLC |
5% Or Greater Indirect Ownership Interest | Dec 1, 2021 | 95% |
| Mick Vujanovic |
Corporate Officer |
Dec 1, 2021 | |
| Operational/Managerial Control |
Dec 1, 2021 | ||
| Clearview Ky SNF Holdco LLC |
5% Or Greater Indirect Ownership Interest | Dec 1, 2021 | 100% |
| Clearview Healthcare Management Ky LLC |
Operational/Managerial Control | Jan 1, 2020 | |
| Zanziper Family Trust |
5% Or Greater Indirect Ownership Interest | Dec 1, 2021 | 47.5% |
| Amanda Coleman |
W-2 Managing Employee |
Oct 1, 2019 | |
| HC Family Trust |
5% Or Greater Indirect Ownership Interest | Dec 1, 2021 | 47.5% |
| Sweet Home Management LLC |
5% Or Greater Indirect Ownership Interest | Dec 1, 2021 | 5% |
| Ky M53 Spe Opco Holdco LLC |
5% Or Greater Direct Ownership Interest | Dec 1, 2021 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200204000932 | KY | Part a Provider - Skilled Nursing Facility | 1052747490 | Practice locations: Princeton, KY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes | ||
| Respite Care | 385H00000X |
Addresses
Primary practice location
1333 W Main St
Princeton, KY 42445-6211
Mailing address
2100 Cherokee Ridge Way Ste 100
Louisville, KY 40205-1600
Phone (502) 667-8150
Other names
- Princeton Nursing & Rehabilitation
Other providers in Princeton, KY
- Shanna Phillips
- Rebecca Sue Porter
- Primaricare, PLLC
- Princeton Family Care, PLLC
- Princeton Health & Rehab Center, Inc.
- Princeton Opco LLC
- Kendyll Jaymes Prowell
- David Henry Ramey
- Sonja Lee Ramey
- Heather Michelle Reddick
All providers in Princeton, KY · Skilled Nursing Facility in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 9, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.