Organization Active NPI

Amherst SNF Operations LLC

Doing business as Fairmont Crossing Health and Rehab Center

  • Skilled Nursing Facility
  • Amherst, VA
National Provider Identifier
1174297063
Registry record updated Nov 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
AMHERST SNF OPERATIONS LLC
Doing business as
Fairmont Crossing Health and Rehab Center
Practice address
173 Brockman Park Dr
Amherst, VA 24521-2583
Phone
(434) 946-2850
NPI assigned
Aug 4, 2021
Last updated
Nov 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2021

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

Authorized official

Name
Joseph Lieberman
Title
Director of Financial Operations
Phone
(516) 855-5504

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

173 Brockman Park Dr
Amherst, VA 24521-2583

Mailing address

1007 Broadway
Woodmere, NY 11598-1246

Other names 1

  • Fairmont Crossing Health and Rehab Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220127000778 VA Part A Provider - Skilled Nursing Facility 9931591831 Practice locations: Amherst, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174297063. Details of each certification follow.

Skilled nursing facility certification: CCN 495363

Legal name
AMHERST SNF OPERATIONS LLC
Doing business as
FAIRMONT CROSSING HEALTH AND REHAB CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 5, 2002
Last certification
Jun 2, 2022
Beds
120
Ownership / control type
Corporation
Multi-facility organization
Hill Valley Healthcare
Organization structure
LLCProprietary
Incorporated
May 11, 2021 in VA
Enrollment address
173 Brockman Park Dr
Amherst, VA 24521-2583
Nursing home name
FAIRMONT CROSSING HEALTH AND REHAB CENTER
Affiliated entity
HILL VALLEY HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Fairmont Crossing Health and Rehab CenterCCN 495363 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 5, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120112.6 residents per day on average
Chain
Hill Valley Healthcare43 facilities in the chain
Penalties (3 years)
1Fines totaling $12,740

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D0997395Fairmont Crossing Health & Rehab Center173 Brockman Park Drive, Amherst, VA 24521Certificate of waiverMar 13, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Timberlake Operations Holdings LLC Organization, Woodmere, NY LLC 5% Or Greater Indirect Ownership Interest Nov 1, 2021 100%
Sabrina 1818 Holdings LLC Organization, Flushing, NY LLC 5% Or Greater Indirect Ownership Interest Nov 1, 2021 47.5%
Saessy Irrevocable Trust Organization, Cleveland, OH 5% Or Greater Indirect Ownership Interest Nov 1, 2021 45.2%
Sarah M Wade Individual W-2 Managing EmployeeAdmin Nov 1, 2021
HVH Timberlake Management LLC Organization, Woodmere, NY LLC Operational/Managerial Control Nov 1, 2021 100%
Shimon Idels Individual Corporate Officer Nov 1, 2021
Delilah 2626 Holdings LLC Organization, Flushing, NY LLC 5% Or Greater Indirect Ownership Interest Nov 1, 2021 5%
Tatiriq Irrevocable Trust Organization, Flushing, NY 5% Or Greater Indirect Ownership Interest Nov 1, 2021 45.2%
Lion 26 Holdings LLC Organization, Flushing, NY LLC 5% Or Greater Indirect Ownership Interest Nov 1, 2021 47.5%
Amherst SNF Holdings LLC Organization, Woodmere, NY Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Nov 1, 2021 100%

Facilities with the same owner 47

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1628035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636070400000",
    "number": "1174297063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 BROADWAY",
            "city": "WOODMERE",
            "state": "NY",
            "postal_code": "115981246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 BROCKMAN PARK DR",
            "city": "AMHERST",
            "state": "VA",
            "postal_code": "245212583",
            "telephone_number": "434-946-2850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMHERST SNF OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-04",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A",
        "authorized_official_last_name": "LIEBERMAN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCIAL OPERATIONS",
        "authorized_official_telephone_number": "516-855-5504"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairmont Crossing Health and Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Amherst, VA

Sources for this page

Verify at the official NPI Registry.