Active NPI
Kingston SNF Healthcare, LLC
- Skilled Nursing Facility
- Kingston, PA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- KINGSTON SNF HEALTHCARE, LLC
- Doing business as
- Third Avenue Health & Rehab Center
- Practice address
- 702 3Rd Ave
Kingston, PA 18704-5845 - Phone
- (570) 283-5848
- Fax
- (570) 283-6908
- NPI assigned
- Apr 22, 2014
- Organization subpart
- Yes
- Parent organization
- SABER HEALTHCARE HOLDINGS, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- William I. Weisberg
- Title
- President
- Phone
- (216) 292-5706
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
702 3Rd Ave
Kingston, PA 18704-5845
Mailing address
23700 Commerce Park
Beachwood, OH 44122-5827
Phone (216) 292-5706
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102914366-0001 | Medicaid | PA |
Other names 1
- Third Avenue Health & Rehab Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140624000187 | PA | Part A Provider - Skilled Nursing Facility | 0042434565 | Practice locations: Kingston, PA |
Skilled nursing facility certification: CCN 395905
- Legal name
- KINGSTON SNF HEALTHCARE LLC
- Doing business as
- THIRD AVENUE HEALTH & REHAB CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 9, 1993
- Last certification
- May 30, 2025
- Beds
- 65
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Saber PA Holdings, LLC
- Organization structure
- LLC
- Incorporated
- Feb 20, 2014 in PA
- Enrollment address
- 702 3Rd Ave
Kingston, PA 18704-5845 - Nursing home name
- THIRD AVENUE HEALTH & REHAB CENTER
- Affiliated entity
- SABER HEALTHCARE GROUP
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Third Avenue Health & Rehab Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Aug 9, 1993
- Medicare certification status
- Active
- Certified beds
- 65
- Chain
- Saber Healthcare Group
National Provider Directory
National Provider Directory- Tax ID family
- Kingston Health Care Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Skilled Nursing Facility
- Kingston, PA
- NPI 1811983687
Ownership & related parties
All disclosed owners & managing parties 18
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Saber Healthcare Holdings LLC | 5% Or Greater Indirect Ownership Interest | Dec 31, 2023 | 100% |
| Loren Mangino | Adp of the SNF | Jun 24, 2024 | |
| Jenna Lutchko | Operational/Managerial Control | Jun 22, 2024 | |
| Adp of the SNF | Jun 22, 2024 | ||
| Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020) | 5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 33% |
| Gregory Nicoluzakis | Corporate Officer | Mar 1, 2019 | |
| Adp of the SNF | Mar 1, 2019 | ||
| SHG Management LLC | Operational/Managerial Control | Sep 1, 2019 | |
| Adp of the SNF | Sep 1, 2019 | ||
| Saber Governance LLC | Operational/Managerial Control | Sep 1, 2019 | |
| Adp of the SNF | Sep 1, 2019 | ||
| Saber Healthcare Group LLC | Adp of the SNF | Jul 1, 2014 | |
| BNV Dynasty LLC | 5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 33% |
| Kingston SNF Re Group LLLC | Adp of the SNF | Mar 1, 2024 | |
| Benjamin N Volpe | Corporate Officer | Mar 1, 2019 | |
| Corporate Director | Mar 1, 2019 | 50% | |
| Saber PA Holdings, LLC | 5% Or Greater Direct Ownership Interest | Dec 31, 2023 | 100% |
| Citrin Cooperman Advisors LLC | Adp of the SNF | Jul 1, 2014 | |
| Wiw Dynasty LLC | 5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 67% |
| William I Weisberg | Corporate Officer | Mar 1, 2019 | |
| Corporate Director | Mar 1, 2019 | 50% | |
| RKL LLP | Adp of the SNF | Jan 26, 2023 | |
| Lori Sakalas | Operational/Managerial Control | May 6, 2024 | |
| Adp of the SNF | May 6, 2024 | ||
| Decanted William I. Weisberg Family Dynasty Trust (Dated Sept 30, 2020 | 5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 67% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
Facilities with the same owner 122
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Skilled Nursing Facility
- Ambler, PA
- NPI 1063711786
Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Decanted William I. Weisberg Family Dynasty Trust (Dated Sept 30, 2020, Saber Governance LLC, Saber Healthcare Holdings LLC, Saber PA Holdings, LLC, SHG Management LL
-
- Skilled Nursing Facility
- Frackville, PA
- NPI 1033619333
Saber PA Holdings, LLC, SHG Management LLC
-
- Skilled Nursing Facility
- Broomall, PA
- NPI 1821261710
Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Decanted William I. Weisberg Family Dynasty Trust (Dated Sept 30, 2020, Saber Healthcare Holdings LLC, Saber PA Holdings, LLC, SHG Management LLC, Wiw Dynasty LLC
-
- Skilled Nursing Facility
- Bryn Mawr, PA
- NPI 1801195524
Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Decanted William I. Weisberg Family Dynasty Trust (Dated Sept 30, 2020, Saber Governance LLC, Saber Healthcare Holdings LLC, Saber PA Holdings, LLC, Wiw Dynasty LLC
-
- Skilled Nursing Facility
- Harrisburg, PA
- NPI 1447961636
Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Decanted William I. Weisberg Family Dynasty Trust (Dated Sept 30, 2020, Saber Healthcare Holdings LLC, Saber PA Holdings, LLC, SHG Management LLC, Wiw Dynasty LLC
-
- Skilled Nursing Facility
- Chatham, PA
- NPI 1568600849
Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Decanted William I. Weisberg Family Dynasty Trust (Dated Sept 30, 2020, Saber Governance LLC, Saber Healthcare Holdings LLC, Saber PA Holdings, LLC, SHG Management LL
-
- Skilled Nursing Facility
- Fort Washington, PA
- NPI 1538676036
Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Decanted William I. Weisberg Family Dynasty Trust (Dated Sept 30, 2020, Saber Governance LLC, Saber Healthcare Holdings LLC, Saber PA Holdings, LLC, SHG Management LL
-
- Skilled Nursing Facility
- Dunmore, PA
- NPI 1942423454
Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Decanted William I. Weisberg Family Dynasty Trust (Dated Sept 30, 2020, Saber Governance LLC, Saber Healthcare Holdings LLC, Saber PA Holdings, LLC, SHG Management LL
-
- Skilled Nursing Facility
- Pittsburgh, PA
- NPI 1720790769
Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Decanted William I. Weisberg Family Dynasty Trust (Dated Sept 30, 2020, Saber Governance LLC, Saber Healthcare Holdings LLC, Saber PA Holdings, LLC, SHG Management LL
-
- Skilled Nursing Facility
- Elkins Park, PA
- NPI 1932609237
Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Decanted William I. Weisberg Family Dynasty Trust (Dated Sept 30, 2020, Saber Governance LLC, Saber Healthcare Holdings LLC, Saber PA Holdings, LLC, SHG Management LL
-
- Skilled Nursing Facility
- Scranton, PA
- NPI 1194015784
Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Decanted William I. Weisberg Family Dynasty Trust (Dated Sept 30, 2020, Saber Healthcare Holdings LLC, Saber PA Holdings, LLC, SHG Management LLC, Wiw Dynasty LLC
-
- Skilled Nursing Facility
- Greensburg, PA
- NPI 1245941442
Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Decanted William I. Weisberg Family Dynasty Trust (Dated Sept 30, 2020, Saber Governance LLC, Saber Healthcare Holdings LLC, Saber PA Holdings, LLC, SHG Management LL
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Kingston, PA
- NPI 1750477139
-
- Family Medicine Physician
- Forty Fort, PA
- NPI 1851730550
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398124800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1683590400000",
"number": "1194145706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23700 COMMERCE PARK",
"city": "BEACHWOOD",
"state": "OH",
"postal_code": "441225827",
"telephone_number": "216-292-5706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "702 3RD AVE",
"city": "KINGSTON",
"state": "PA",
"postal_code": "187045845",
"telephone_number": "570-283-5848",
"fax_number": "570-283-6908"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KINGSTON SNF HEALTHCARE, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SABER HEALTHCARE HOLDINGS, LLC",
"enumeration_date": "2014-04-22",
"last_updated": "2023-05-09",
"certification_date": "2023-05-09",
"status": "A",
"authorized_official_last_name": "WEISBERG",
"authorized_official_first_name": "WILLIAM",
"authorized_official_middle_name": "I.",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "216-292-5706"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102914366-0001",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Third Avenue Health & Rehab Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Kingston, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; 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.