521 Pine Brook Operating, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

061408 Issued in NJ

Legal business name

521 PINE BROOK OPERATING, LLC

Practice address

521 Pine Brook Rd
Lincoln Park, NJ 07035-1801

Phone

(973) 696-3300

NPI assigned

Dec 26, 2012

Organization subpart

Yes

Parent organization

521 PINE BROOK VENTURES, LLCAs reported in NPPES

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

Authorized official

Name

Charles-Edouard Gros

Title

Managing Member

Phone

(973) 696-3300

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Lincoln Park Renaissance Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Skilled nursing facility certification: CCN 315042

Legal name

521 PINE BROOK OPERATING LLC

Doing business as

LINCOLN PARK RENAISSANCE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 1, 1967

Last certification

Oct 10, 2024

Beds

189

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Incorporated

Sep 6, 2012 in NJ

Enrollment address

521 Pine Brook Rd
Lincoln Park, NJ 07035-1801

Nursing home name

LINCOLN PARK RENAISSANCE

Affiliated entity

CENTER MANAGEMENT GROUP

Listed as

Lincoln Park RenaissanceCCN 315042

Overall star rating

4 of 5

Health inspections

3 of 5

Staffing

2 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jan 1, 1967

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

189178.5 residents per day on average

Chain

Center Management Group16 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

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.

• Anthony J Barravecchio, D.O.

  • Internal Medicine Physician
  • Wayne, NJ
  • NPI 1114996477

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 2

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

• Anthony J Barravecchio, D.O.

  • Internal Medicine Physician
  • Wayne, NJ
  • NPI 1114996477
  NPD (past)
• Liviu Rappaport, M.D.

  • Internal Medicine Physician
  • Wayne, NJ
  • NPI 1629013933
  NPD (past)

Affiliated clinicians 4

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

• Elsaid Balboul, MD

  • Internal Medicine Physician
  • Wayne, NJ
  • NPI 1467421339

  Nursing home

  Care Compare affiliation
• Anthony J Barravecchio, D.O.

  • Internal Medicine Physician
  • Wayne, NJ
  • NPI 1114996477

  Nursing home

  Care Compare affiliation
• Manish P Luhana, M.D.

  • Internal Medicine Physician
  • Parsippany, NJ
  • NPI 1558347641

  Nursing home

  Care Compare affiliation
• Liviu Rappaport, M.D.

  • Internal Medicine Physician
  • Wayne, NJ
  • NPI 1629013933

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1356480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356480000000",
    "number": "1306182159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "499 PINE BROOK RD",
            "city": "LINCOLN PARK",
            "state": "NJ",
            "postal_code": "070351804",
            "telephone_number": "973-696-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 PINE BROOK RD",
            "city": "LINCOLN PARK",
            "state": "NJ",
            "postal_code": "070351801",
            "telephone_number": "973-696-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "521 PINE BROOK OPERATING, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "521 PINE BROOK VENTURES, LLC",
        "enumeration_date": "2012-12-26",
        "last_updated": "2012-12-26",
        "status": "A",
        "authorized_official_last_name": "GROS",
        "authorized_official_first_name": "CHARLES-EDOUARD",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "973-696-3300"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NJ",
            "license": "061408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4491904",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01216893",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lincoln Park Renaissance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 499 Pine Brook Operating, LLC
• Gadeer Abdellateef
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• Evelyn Adamski, RPH
• Advanced Chiropractic Care, PC
• Advanced Injury Care II, Inc.

• All providers in Lincoln Park, NJ
• Skilled Nursing Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 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.