5000 Sowul Boulevard Opco LLC
Organization Active NPI Skilled Nursing Facility · Stow, OH
NPI 1295578243 · NPPES record last updated Jul 2, 2024
Key facts
- NPI
- 1295578243
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- 5000 SOWUL BOULEVARD OPCO LLC
- Practice address
- 5000 Sowul Blvd
Stow, OH 44224-6092 - Phone
- (330) 653-8722
- NPI assigned
- Jun 17, 2024
- Organization subpart
- No
Authorized official
- Name
- Rachel Friedman
- Title
- Manager
- Phone
- (516) 545-0980
Facilities with the same owner 3
Practitioners 1
-
Douglas R Kast, D.O.
Affiliated clinicians 1
-
Douglas R Kast, D.O.
Medicare Care Compare: Nursing home
- Listed as
- Hudson Springs Nursing and Rehab
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★☆☆☆ 2 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Nov 17, 2015
- Medicare certification status
- Active
- Certified beds
- 80 · 71.7 residents per day on average
- Chain
- Garden Springs Healthcare
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D2314260 | Hudson Springs Nursing and Rehab Laboratory | Accreditation | Oct 20, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Skilled nursing facility certification: CCN 366434
- Legal name
- 5000 SOWUL BOULEVARD OPCO LLC
- Doing business as
- HUDSON SPRINGS NURSING AND REHAB
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 17, 2015
- Last certification
- Aug 21, 2024
- Beds
- 80
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Garden Springs Healthcare
- Organization structure
- LLC · Proprietary
- Incorporated
- Dec 26, 2023 in OH
- Enrollment address
- 5000 Sowul Blvd
Stow, OH 44224-6092 - Nursing home name
- HUDSON SPRINGS NURSING AND REHAB
- Affiliated entity
- GARDEN SPRINGS HEALTHCARE
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Ilya Rafi Mahilnitski |
5% Or Greater Direct Ownership Interest | Jun 27, 2024 | 35% |
| Corporate Officer |
Jun 27, 2024 | 50% | |
| Operational/Managerial Control | Jun 27, 2024 | ||
| Managing Control - Governing Body | Jun 27, 2024 | ||
| Adp of the SNF | Jun 27, 2024 | ||
| Pessi Friedman |
5% Or Greater Direct Ownership Interest | Jun 27, 2024 | 1% |
| Tiffany Wade |
Operational/Managerial Control | Jun 27, 2024 | |
| Managing Control - Governing Body |
Jun 27, 2024 | ||
| Adp of the SNF | Jun 27, 2024 | ||
| Yfr Equities LLC |
5% Or Greater Direct Ownership Interest | Jun 27, 2024 | 4% |
| Matis Mark Friedman |
5% Or Greater Direct Ownership Interest | Jun 27, 2024 | 46% |
| 5% Or Greater Indirect Ownership Interest | Jun 27, 2024 | 4.67% | |
| Corporate Officer |
Jun 27, 2024 | 50% | |
| Corporate Director |
Jun 27, 2024 | 100% | |
| Operational/Managerial Control | Jun 27, 2024 | ||
| Managing Control - Governing Body |
Jun 27, 2024 | ||
| Adp of the SNF | Jun 27, 2024 | ||
| |
Adp of the SNF | Jan 13, 2025 | |
| |
Direct Ownership Interest | Jun 27, 2024 | 3% |
| Gitty Friedman |
5% Or Greater Direct Ownership Interest | Jun 27, 2024 | 2% |
| |
Adp of the SNF | Jan 13, 2025 | |
| Bryan Barenbaum |
5% Or Greater Direct Ownership Interest |
Jun 27, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250113001799 | OH | Part a Provider - Skilled Nursing Facility | 9830627272 | Practice locations: Stow, OH |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
5000 Sowul Blvd
Stow, OH 44224-6092
Mailing address
30100 Chagrin Blvd Ste 202
Pepper Pike, OH 44124-5722
Other providers in Stow, OH
- Theckla Adu Abang
- Abby Gontero LLC
- Khalid Abdussalaam
- Amanda Rose Abegglen
- Accuquest Hearing Center, LLC
All providers in Stow, OH · Skilled Nursing Facility in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 2, 2024. 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.