2215 Northport Opco LLC
Organization Active NPI Skilled Nursing Facility · Northport, AL
NPI 1245700467 · NPPES record last updated Apr 17, 2020
Key facts
- NPI
- 1245700467
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- 2215 NORTHPORT OPCO LLC
- Practice address
- 2215 32ND St
Northport, AL 35476-5230 - Phone
- (205) 339-5400
- Fax
- (205) 339-3455
- NPI assigned
- Nov 30, 2018
- Organization subpart
- No
Authorized official
- Name
- Shalom Lerner
- Title
- Manager
- Phone
- (718) 564-6560
Practitioners 1
-
Joseph Grier Stewart Jr., M.D.
Affiliated clinicians 1
-
Joseph Grier Stewart Jr., M.D.
Medicare Care Compare: Nursing home
- Listed as
- Forest Manor Health and Rehab
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Aug 1, 1976
- Medicare certification status
- Active
- Certified beds
- 182 · 157.2 residents per day on average
- Chain
- Venza Care Management
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Skilled nursing facility certification: CCN 015143
- Legal name
- 2215 NORTHPORT OPCO LLC
- Doing business as
- FOREST MANOR HEALTH AND REHAB
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 1, 1976
- Last certification
- May 13, 2021
- Beds
- 182
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- Aug 21, 2018 in AL
- Enrollment address
- 2215 32ND St
Northport, AL 35476-5230 - Nursing home name
- FOREST MANOR HEALTH AND REHAB
- Affiliated entity
- VENZA CARE MANAGEMENT
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Kelvin R Robertson |
W-2 Managing Employee |
Feb 1, 2023 | 100% |
| 2672 Equities LLC |
5% Or Greater Direct Ownership Interest | Jan 1, 2019 | 25% |
| Shaul Kopelowitz |
5% Or Greater Direct Ownership Interest | Jan 1, 2019 | 10% |
| Shalom Lerner |
5% Or Greater Direct Ownership Interest | Jan 1, 2019 | 25% |
| Corporate Officer |
Jan 1, 2019 | 100% | |
| Operational/Managerial Control |
Jan 1, 2019 | ||
| Yisroel E Herzka |
5% Or Greater Direct Ownership Interest | Jan 1, 2019 | 36% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190108001877 | AL | Part a Provider - Skilled Nursing Facility | 0547506875 | Practice locations: Northport, AL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
2215 32ND St
Northport, AL 35476-5230
Mailing address
2215 32ND St
Northport, AL 35476-5230
Phone (205) 339-5400
Other names
- Forest Manor Health and Rehab
Other providers in Northport, AL
- Jane Ellen Abel
- Adams Therapeutic Consultations, LLC
- Kyle David Adams
- Addiction & Mental Health Services, LLC
- Advance Pediatric & Adult Therapy,LLC.
All providers in Northport, AL · Skilled Nursing Facility in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2020. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.