Penney Retirement Community, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1325096 Issued in FL

Legal business name

PENNEY RETIREMENT COMMUNITY, INC.

Practice address

1 Pavilion Place
Penney Farms, FL 32079-0555

Phone

(904) 284-8582

Fax

(904) 284-6259

NPI assigned

Apr 16, 2012

Last updated

Apr 16, 2012By 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

Ms. Barbara Marie Engelkes, LNHA

Title

Administrator

Phone

(904) 284-8582

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 1285991265. Details of each certification follow.

• CCN 106096 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 106096

Legal name

PENNEY RETIREMENT COMMUNITY, INC.

Doing business as

THE PAVILION FOR HEALTHCARE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Dec 27, 2012

Last certification

Jun 20, 2024

Beds

50

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Enrollment address

3465 Caroline Blvd
Penney Farms, FL 32079

Nursing home name

PAVILION FOR HEALTH CARE, THE

Listed as

Pavilion for Health Care, theCCN 106096 · All quality measures

Overall star rating

5 of 5

Health inspections

5 of 5

Staffing

5 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Dec 27, 2012

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

5044.7 residents per day on average

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

Tax ID family

Penney Retirement Community3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Outpatient Clinic at Penney Retirement Community, Inc.

  • Family Medicine Physician
  • Penney Farms, FL
  • NPI 1578919080
  NPD tax ID
• Penney Retirement Community

  • Nursing Facility/Intermediate Care Facility
  • Penney Farms, FL
  • NPI 1700021599
  NPD tax ID

All disclosed owners & managing parties 19

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.

• Hani Issa, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Penny Farms, FL
  • NPI 1619144045

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alyssa Durano

  • Occupational Therapy Assistant
  • Green Cove Springs, FL
  • NPI 1598347809
  NPD (past)
• Charlotte Fountain Faulkner

  • Speech-Language Pathologist
  • Green Cove Springs, FL
  • NPI 1366179160
  NPD (past)
• Cindy Fonthus Cineas

  • Occupational Therapy Assistant
  • Green Cove Springs, FL
  • NPI 1033858113
  NPD (past)
• Estrella Jane A. Pena, PT

  • Physical Therapist
  • Green Cove Springs, FL
  • NPI 1336894930
  NPD (past)

Affiliated clinicians 3

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

• Matthew Todd Braddock, D.O.

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1417180886

  Nursing home

  Care Compare affiliation
• Hani Issa, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Penny Farms, FL
  • NPI 1619144045

  Nursing home

  Care Compare affiliation
• William Herman Sessions, M.D.

  • Family Medicine Physician
  • Fleming Island, FL
  • NPI 1669471033

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1334534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334534400000",
    "number": "1285991265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 555",
            "city": "PENNEY FARMS",
            "state": "FL",
            "postal_code": "320790555",
            "telephone_number": "904-284-8582",
            "fax_number": "904-284-6259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PAVILION PLACE",
            "city": "PENNEY FARMS",
            "state": "FL",
            "postal_code": "320790555",
            "telephone_number": "904-284-8582",
            "fax_number": "904-284-6259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNEY RETIREMENT COMMUNITY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-16",
        "last_updated": "2012-04-16",
        "status": "A",
        "authorized_official_last_name": "ENGELKES",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-284-8582",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1325096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristina Ketterer, COTA
• Janet Keys, PTA
• Katarina Elaine Norton
• Outpatient Clinic at Penney Retirement Community, Inc.
• Penney Retirement Community
• Tonyo Lorenzo Sylvester
• Laura E Watkins, PTA

• Skilled Nursing Facility in Penney Farms, FL
• Providers in Penney Farms, 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 Apr 16, 2012; 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.