NPIMap

Organization Active NPI

St. Johnland Nursing Center, Inc.

  • Skilled Nursing Facility
  • Kings Park, NY
National Provider Identifier
1295744761
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
5157311N Issued in NY
Legal business name
ST. JOHNLAND NURSING CENTER, INC.
Practice address
395 Sunken Meadow Road
St. Johnland Nursing Center, Inc
Kings Park, NY 11780
Phone
(631) 269-5800
Fax
(631) 269-5876
NPI assigned
Aug 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Mary Jean Weber, LNHA
Title
Ceo Adminstrator
Phone
(631) 269-5800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 5157311N NY Primary

Addresses

Primary practice location

395 Sunken Meadow Road
St. Johnland Nursing Center, Inc
Kings Park, NY 11780

Mailing address

395 Sunken Meadow Road
St. Johnland Nursing Center, Inc.
Kings Park, NY 11780
Phone (631) 269-5800

Other identifiers 1

IdentifierTypeStateIssuer
00309393MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070608000048 NY Part A Provider - Skilled Nursing Facility 9234028929 Practice locations: Kings Park, NY

Skilled nursing facility certification: CCN 335487

Legal name
ST. JOHNLAND NURSING CENTER, INC.
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 27, 1975
Last certification
Dec 10, 2024
Beds
250
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1984 in NY
Enrollment address
395 Sunken Meadow Rd
Kings Park, NY 11754-1000
Nursing home name
ST JOHNLAND NURSING CENTER

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
St Johnland Nursing CenterCCN 335487
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Dec 27, 1975
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
250205.4 residents per day on average
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
1Fines totaling $30,817

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
St Johnland Nursing Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

395 Sunken Meadow Rd
Kings Park, NY 11754
Phone (631) 269-5800

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Yelena M Faynzilbert Individual Operational/Managerial Control May 1, 2021
Adp of the SNF Apr 24, 2025
Arlene Q Vermylen Individual Corporate Director Mar 31, 2020
Marion Conway Individual Corporate Director Mar 31, 2020
Michael Agnes Individual Corporate Director Mar 31, 2020
Michael Tretola Individual Corporate DirectorCeo Sep 11, 2023
Operational/Managerial Control Sep 11, 2023
Adp of the SNF May 12, 2025
Joseph Santangelo Individual Corporate Director Mar 31, 2020
Operational/Managerial Control Mar 31, 2020
Carl Doerge Individual Corporate Director May 23, 1998
Heather L Lane Individual Corporate Director Mar 31, 2020
David H Deming Individual Corporate Director Mar 31, 2020

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 7

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

Affiliated clinicians 4

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": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295744761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 SUNKEN MEADOW ROAD",
            "address_2": "ST. JOHNLAND NURSING CENTER, INC.",
            "city": "KINGS PARK",
            "state": "NY",
            "postal_code": "11780",
            "telephone_number": "631-269-5800",
            "fax_number": "631-269-5876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 SUNKEN MEADOW ROAD",
            "address_2": "ST. JOHNLAND NURSING CENTER, INC",
            "city": "KINGS PARK",
            "state": "NY",
            "postal_code": "11780",
            "telephone_number": "631-269-5800",
            "fax_number": "631-269-5876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHNLAND NURSING CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WEBER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "CEO ADMINSTRATOR",
        "authorized_official_telephone_number": "631-269-5800",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "5157311N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00309393",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kings Park, NY

Sources for this page

Verify at the official NPI Registry.