NPIMap

Organization Active NPI

19 Obery Street Operator LLC

  • Skilled Nursing Facility
  • Plymouth, MA
National Provider Identifier
1295264679
Registry record updated Jun 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
19 OBERY STREET OPERATOR LLC
Practice address
19 Obery St
Plymouth, MA 02360-2129
Phone
(508) 747-4790
Fax
(508) 746-3880
NPI assigned
Jun 8, 2017
Last updated
Jun 8, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
NEXT STEP HEALTHCARE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 8, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William Howard Stephan
Title
Chief Financial Officer
Phone
(617) 943-7747

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

19 Obery St
Plymouth, MA 02360-2129

Mailing address

75 2ND Ave Ste 605
Needham, MA 02494-2863
Phone (617) 943-7747

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170817002323 MA Part A Provider - Skilled Nursing Facility 5496027963 Practice locations: Plymouth, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295264679. Details of each certification follow.

Skilled nursing facility certification: CCN 225284

Legal name
19 OBERY STREET OPERATOR LLC
Doing business as
PLYMOUTH HARBORSIDE HEALTHCARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 1, 1985
Last certification
Oct 23, 2024
Beds
101
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Next Step Health Care
Organization structure
LLCProprietary
Incorporated
Apr 6, 2017 in MA
Enrollment address
19 Obery St
Plymouth, MA 02360-2129
Nursing home name
PLYMOUTH HARBORSIDE HEALTHCARE
Affiliated entity
NEXT STEP HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Plymouth Harborside HealthcareCCN 225284 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
2 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 1, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10177.4 residents per day on average
Chain
Next Step Healthcare14 facilities in the chain
Special focus status
SFF Candidate
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
6Fines totaling $321,400

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D2139934Plymouth Harborside Healthcare19 Obery, Plymouth, MA 02360Certificate of waiverNov 12, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Rohit Rattan Individual Operational/Managerial Control Nov 8, 2023
Adp of the SNF Nov 8, 2023
William Stephan Individual 5% Or Greater Indirect Ownership InterestCfo Sep 1, 2017 50%
Corporate OfficerChief Financial Officer Sep 1, 2017 50%
Indirect Ownership Interest Sep 1, 2017 50%
Nina Nguyen Individual Operational/Managerial Control Apr 14, 2025
Adp of the SNF Apr 14, 2025
Damian Dell'Anno Individual 5% Or Greater Indirect Ownership InterestCeo Sep 1, 2017 50%
Corporate OfficerChief Executive Officer Sep 1, 2017 50%
Indirect Ownership Interest Sep 1, 2017 50%
Next Step Healthcare LLC Organization, Woburn, MA Created for acquisition, LLC, Chain home office, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Sep 1, 2017 100%
Operational/Managerial Control Sep 1, 2017 100%
Adp of the SNF Jun 24, 2025
Direct Ownership Interest Sep 1, 2017 100%

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 13

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

View all 13

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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.

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": "1496880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496880000000",
    "number": "1295264679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 2ND AVE STE 605",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024942863",
            "telephone_number": "617-943-7747",
            "fax_number": "617-454-1051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 OBERY ST",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023602129",
            "telephone_number": "508-747-4790",
            "fax_number": "508-746-3880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "19 OBERY STREET OPERATOR LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEXT STEP HEALTHCARE LLC",
        "enumeration_date": "2017-06-08",
        "last_updated": "2017-06-08",
        "status": "A",
        "authorized_official_last_name": "STEPHAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "HOWARD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "617-943-7747"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MA

Sources for this page

Verify at the official NPI Registry.