NPIMap

Organization Active NPI

Dover Manor Operations LLC

  • Skilled Nursing Facility
  • Georgetown, KY
National Provider Identifier
1306553052
Registry record updated Nov 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
DOVER MANOR OPERATIONS LLC
Practice address
112 Dover Drive
Georgetown, KY 40324
Phone
(859) 623-0898
NPI assigned
Nov 2, 2022
Last updated
Nov 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

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

Authorized official

Name
Mayer Fischl
Title
Owner/Managing Member
Phone
(718) 757-6399

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

112 Dover Drive
Georgetown, KY 40324

Mailing address

300 Provider Court
Richmond, KY 40475

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230301000855 KY Part A Provider - Skilled Nursing Facility 3072986637 Practice locations: Georgetown, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306553052. Details of each certification follow.

Skilled nursing facility certification: CCN 185295

Legal name
DOVER MANOR OPERATIONS LLC
Doing business as
DOVER NURSING & REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 14, 1991
Last certification
Dec 13, 2024
Beds
85
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
112 Dover Dr
Georgetown, KY 40324-9741
Nursing home name
DOVER NURSING & REHABILITATION CENTER
Affiliated entity
BLUEGRASS HEALTH KY

Care Compare: Nursing home

Medicare Care Compare
Listed as
Dover Nursing & Rehabilitation CenterCCN 185295 · All quality measures
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 14, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8578.5 residents per day on average
Chain
Bluegrass Health Ky15 facilities in the chain
Penalties (3 years)
1Fines totaling $163,742

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

112 Dover Dr
Georgetown, KY 40324
Phone (502) 863-9529

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Individual Adp of the SNF Jan 1, 2023
Natasha Rayburn Individual Operational/Managerial Control Jan 31, 2023
Mayer Fischel Individual 5% Or Greater Indirect Ownership InterestCfo Jan 1, 2023 33.33%
Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023
Ralph a Alvarado Individual Adp of the SNF Jun 1, 2023
Dover Manor Realty LLC Organization, Richmond, KY LLC Adp of the SNF Jan 1, 2023
Individual Adp of the SNF Jan 1, 2023
Dover Manor Realty Holdings LLC Organization, Richmond, KY LLC Adp of the SNF Jan 1, 2023
Individual Adp of the SNF Jan 1, 2023
Huntington Bank Organization, Columbus, OH Corporation, Financial institution, Owned by another organization or individual 5% Or Greater Mortgage Interest Jan 1, 2023 74%
Valley Stream Operator I LLC Organization, Richmond, KY Management services company, Chain home office Operational/Managerial Control Jan 1, 2023
Adp of the SNF Apr 23, 2025
Individual Adp of the SNF Jan 1, 2023
Organization, Richmond, KY LLC Adp of the SNF Apr 23, 2025
Individual Adp of the SNF Jan 1, 2023
Organization, Russellville, KY LLC Adp of the SNF Apr 23, 2025
Eli Grinspan Individual 5% Or Greater Indirect Ownership InterestCoo Jan 1, 2023 33.33%
Corporate OfficerCoo Jan 1, 2023 100%
Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023
Dover Manor Operations Holdings LLC Organization, Richmond, KY Created for acquisition, LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2023 100%
Individual Adp of the SNF Jan 1, 2023
Benjamin Landa Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2023 33.34%
Individual Adp of the SNF Jan 1, 2023
Shannon Baker Individual Adp of the SNF Apr 1, 2024

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

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": "1667347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667347200000",
    "number": "1306553052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PROVIDER COURT",
            "city": "RICHMOND",
            "state": "KY",
            "postal_code": "40475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 DOVER DRIVE",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "40324",
            "telephone_number": "859-623-0898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOVER MANOR OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-02",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A",
        "authorized_official_last_name": "FISCHL",
        "authorized_official_first_name": "MAYER",
        "authorized_official_title_or_position": "OWNER/MANAGING MEMBER",
        "authorized_official_telephone_number": "718-757-6399"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, KY

Sources for this page

Verify at the official NPI Registry.