11565 Harts Road Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

11565 HARTS ROAD OPCO LLC

Practice address

11565 Harts Rd
Jacksonville, FL 32218-3777

Phone

(732) 719-5034

NPI assigned

Mar 20, 2025

Last updated

Mar 20, 2025By 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

Amitai Dagan

Title

Coo

Phone

(732) 719-5098

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194526731. Details of each certification follow.

• CCN 105632 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 105632

Legal name

11565 HARTS ROAD OPCO LLC

Doing business as

AVIATA AT HARTS HARBOR

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Mar 1, 1989

Last certification

Jun 27, 2024

Beds

180

Ownership / control type

Corporation

Multi-facility organization

Aviata Health Group

Organization structure

LLCProprietary

Enrollment address

11565 Harts Rd
Jacksonville, FL 32218-3777

Nursing home name

AVIATA AT HARTS HARBOR

Affiliated entity

AVIATA HEALTH GROUP

Listed as

Aviata at Harts HarborCCN 105632 · All quality measures

Overall star rating

4 of 5

Health inspections

3 of 5

Staffing

3 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Mar 1, 1989

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

180102.5 residents per day on average

Chain

Aviata Health Group50 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 8

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.

• Joelle M Innocent-Simon, D.O.

  • Family Medicine Physician
  • Starke, FL
  • NPI 1205970134

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 2

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

• Joelle M Innocent-Simon, D.O.

  • Family Medicine Physician
  • Starke, FL
  • NPI 1205970134

  Nursing home

  Care Compare affiliation
• Rickie Sander, MD

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1346200987

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1742428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742428800000",
    "number": "1194526731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "338 WHITESVILLE RD",
            "city": "JACKSON",
            "state": "NJ",
            "postal_code": "085275091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11565 HARTS RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322183777",
            "telephone_number": "732-719-5034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "11565 HARTS ROAD OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-20",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-12",
        "status": "A",
        "authorized_official_last_name": "DAGAN",
        "authorized_official_first_name": "AMITAI",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "732-719-5098"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 11565 Harts Road Operations LLC (Harts Harbor Health Care Center)
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• 1St Care Service & Support, LLC
• 1St Choice Lab and Diagnostics
• 1St Choice Venicare

• Skilled Nursing Facility in Jacksonville, FL
• Providers in Jacksonville, 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 Mar 20, 2025; 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.