NPIMap

Organization Active NPI

Cordova Operating Group LLC

  • Skilled Nursing Facility
  • Cordova, TN
National Provider Identifier
1205499415
Registry record updated Apr 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CORDOVA OPERATING GROUP LLC
Practice address
955 N Germantown Pkwy
Cordova, TN 38018-6215
Phone
(901) 754-1393
NPI assigned
Apr 15, 2019
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Anshel Niederman
Title
Manager
Phone
(929) 900-2005

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 5

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

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 2

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Cordova Wellness and Rehabilitation CenterCCN 445218
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
240163.2 residents per day on average
Chain
Ahava Healthcare16 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Medicare participation

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

Skilled nursing facility certification: CCN 445218

Medicare enrollment files
Legal name
CORDOVA OPERATING GROUP LLC
Doing business as
CORDOVA WELLNESS AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 1, 1989
Last certification
Jun 23, 2022
Beds
240
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Ahava Healthcare
Organization structure
LLCProprietary
Enrollment address
955 N Germantown Pkwy
Cordova, TN 38018-6215
Nursing home name
CORDOVA WELLNESS AND REHABILITATION CENTER
Affiliated entity
AHAVA HEALTHCARE

All disclosed owners & managing parties 11

Medicare enrollment files

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

NameRoleSinceShare
Benjamin Neuman Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2019 10%
Dana a Nash Individual Operational/Managerial Control Jun 1, 2019
Adp of the SNF Mar 25, 2025
Ecm Holdings LLC Organization, Brooklyn, NY LLC, For-profit 5% Or Greater Indirect Ownership Interest Jun 1, 2019 10%
Organization, Brooklyn, NY Chain home office Adp of the SNF Mar 25, 2025
Organization, Jackson, TN LLC Adp of the SNF Mar 25, 2025
BDV Inv Holdco, LLC Organization, Spring Valley, NY LLC, Holding company 5% Or Greater Indirect Ownership Interest Nov 26, 2024 20%
Organization, Pensacola, FL Adp of the SNF Mar 25, 2025
Shiya Labin Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2019 10%
Cordova Holdco LLC Organization, Brooklyn, NY LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Jun 1, 2019 100%
Anshel Niederman Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2019 50%
Corporate Officer Jun 1, 2019
Managing Control - Governing Body Jun 1, 2019
Donni Dubert Individual Operational/Managerial Control Jun 1, 2019
Adp of the SNF Mar 25, 2025

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20190821002327 TN Part a Provider - Skilled Nursing Facility 6406184969 Practice locations: Cordova, TN

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

NPPES NPI Registry

Primary practice location

955 N Germantown Pkwy
Cordova, TN 38018-6215

Mailing address

544 Park Ave Ste B04
Brooklyn, NY 11205-1670
Phone (917) 682-3129

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 15, 2019.

{
    "created_epoch": "1555286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555286400000",
    "number": "1205499415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "544 PARK AVE STE B04",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112051670",
            "telephone_number": "917-682-3129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 N GERMANTOWN PKWY",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380186215",
            "telephone_number": "901-754-1393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORDOVA OPERATING GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-15",
        "last_updated": "2019-04-15",
        "status": "A",
        "authorized_official_last_name": "NIEDERMAN",
        "authorized_official_first_name": "ANSHEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "929-900-2005"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordova, TN

Sources for this page

Verify at the official NPI Registry.