NPIMap

Organization Active NPI

Potomac Operator LLC

  • Skilled Nursing Facility
  • Potomac, MD
National Provider Identifier
1295510402
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
POTOMAC OPERATOR LLC
Practice address
10714 Potomac Tennis LN
Potomac, MD 20854-4418
Phone
(301) 299-2273
NPI assigned
Aug 28, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Authorized official

Name
Boruch Mermelstein
Title
Owner
Phone
(301) 299-2273

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

10714 Potomac Tennis LN
Potomac, MD 20854-4418

Mailing address

10714 Potomac Tennis LN
Potomac, MD 20854-4418
Phone (301) 299-2273

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231023001434 MD Part A Provider - Skilled Nursing Facility 6002262375 Practice locations: Potomac, MD

Skilled nursing facility certification: CCN 215171

Legal name
POTOMAC OPERATOR LLC
Doing business as
MONTCARE AT POTOMAC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 24, 1988
Last certification
Sep 30, 2024
Beds
168
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Sep 1, 2023 in DE
Enrollment address
10714 Potomac Tennis LN
Potomac, MD 20854-4418
Nursing home name
MONTCARE AT POTOMAC

Care Compare: Nursing home

Medicare Care Compare
Listed as
Montcare at PotomacCCN 215171
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 24, 1988
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
168156.0 residents per day on average

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
24D0679060Montcare at Potomac10714 Potomac Tennis la, Potomac, MD 20854Certificate of waiverAug 31, 2026

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
Dov Green Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2023 43%
Boruch D Mermelstein Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2023 45%
Nachum Zager Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2023 10%
Corporate OfficerVice President Sep 1, 2023
Operational/Managerial Control Sep 1, 2023
Cherilyn Poulsen Individual W-2 Managing Employee Sep 1, 2023
MD3 Operator Holdco LLC Organization, Lakewood, NJ Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Sep 1, 2023 100%

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 5

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

Affiliated clinicians 5

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": "1693180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1295510402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10714 POTOMAC TENNIS LN",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208544418",
            "telephone_number": "301-299-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10714 POTOMAC TENNIS LN",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208544418",
            "telephone_number": "301-299-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC OPERATOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-28",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-27",
        "status": "A",
        "authorized_official_last_name": "MERMELSTEIN",
        "authorized_official_first_name": "BORUCH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-299-2273"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Potomac, MD

Sources for this page

Verify at the official NPI Registry.