Active NPI
100 W Queen Street Operations LLC
Doing business as Dallastown Skilled Nursing and Rehabilitation Center
- Skilled Nursing Facility
- Dallastown, PA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- 100 W QUEEN STREET OPERATIONS LLC
- Doing business as
- Dallastown Skilled Nursing and Rehabilitation Center
- Practice address
- 100 W Queen St
Dallastown, PA 17313-2133 - Phone
- (610) 444-6350
- NPI assigned
- Dec 5, 2022
- Last updated
- Jan 6, 2023
- Organization subpart
- Yes
- Parent organization
- GENESIS PM PA OPERATIONS LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael Berg
- Title
- Asst Secretary
- Phone
- (505) 468-4742
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
100 W Queen St
Dallastown, PA 17313-2133
Mailing address
101 E State St
Kennett Square, PA 19348-3109
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39-5451 | Other | MCR |
Other names 1
- DALLASTOWN SKILLED NURSING AND REHABILITATION CENTER
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230222001477 | PA | Part A Provider - Skilled Nursing Facility | 1759754781 | Practice locations: Dallastown, PA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1336859040. Details of each certification follow.
Skilled nursing facility certification: CCN 395451
- Legal name
- 100 W QUEEN STREET OPERATIONS LLC
- Doing business as
- INNERS CREEK SKILLED NURSING AND REHABILITATION CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 17, 1979
- Last certification
- Oct 25, 2024
- Beds
- 202
- Ownership / control type
- Corporation
- Multi-facility organization
- 100 West Queen Street Operations
- Most recent change of ownership
- Feb 1, 2023
- Organization structure
- LLC
- Incorporated
- Nov 14, 2022 in PA
- Enrollment address
- 100 W Queen St
Dallastown, PA 17313-2133 - Nursing home name
- INNERS CREEK SKILLED NURSING AND REHABILITATION CE
- Affiliated entity
- GENESIS HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Inners Creek Skilled Nursing and Rehabilitation Ce
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Oct 17, 1979
- Medicare certification status
- Active
- Certified beds
- 202
- Chain
- Genesis Healthcare
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 2
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 21
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Laura Bridgeford | Corporate Officer | Jun 1, 2024 | 100% |
| HCCF Management Group XI LLC | 5% Or Greater Indirect Ownership Interest | Nov 14, 2022 | 10.8% |
| Gen Operations I LLC | 5% Or Greater Indirect Ownership Interest | Nov 14, 2022 | 100% |
| Brandon M Sparver | Operational/Managerial Control | Mar 11, 2024 | |
| Adp of the SNF | Feb 14, 2025 | ||
| Gen Operations II LLC | 5% Or Greater Indirect Ownership Interest | Nov 14, 2022 | 100% |
| Diane Louise Morris | Operational/Managerial Control | Apr 1, 2024 | |
| FC-Gen Operations Investment LLC | 5% Or Greater Indirect Ownership Interest | Nov 14, 2022 | 100% |
| Sundance Rehabilitation Holdco Inc | 5% Or Greater Indirect Ownership Interest | Nov 14, 2022 | 5.2% |
| Genesis Healthcare LLC | 5% Or Greater Indirect Ownership Interest | Nov 14, 2022 | 100% |
| Sun Healthcare Group Inc | 5% Or Greater Indirect Ownership Interest | Nov 14, 2022 | 65.3% |
| Welltower Op, LLC | 5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 5.7% |
| Genesis Healthcare Inc | 5% Or Greater Indirect Ownership Interest | Nov 14, 2022 | 100% |
| Zac Properties XI LLC | 5% Or Greater Indirect Ownership Interest | Nov 14, 2022 | 7.6% |
| Adp of the SNF | Feb 14, 2025 | ||
| Avi Pinchas Mendelson | Corporate Officer | Jun 1, 2024 | 100% |
| Michael T Berg | Corporate Officer | Nov 14, 2022 | 100% |
| Genesis PM PA Operations LLC | 5% Or Greater Direct Ownership Interest | Nov 14, 2022 | 100% |
| GHC Holdings LLC | 5% Or Greater Indirect Ownership Interest | Nov 14, 2022 | 100% |
| Purvi J Patel | Operational/Managerial Control | Feb 14, 2025 | |
| Adp of the SNF | Feb 14, 2025 | ||
| Genesis Holdings LLC | 5% Or Greater Indirect Ownership Interest | Nov 14, 2022 | 100% |
| Adp of the SNF | Feb 14, 2025 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Geriatric Medicine (Family Medicine) Physician
- York, PA
- NPI 1881714855
Adp of the SNF, Operational/Managerial Control
Facilities with the same owner 176
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Abbeyville Skilled Nursing and Rehabilitation Center
- Skilled Nursing Facility
- Lancaster, PA
- NPI 1467162172
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation
-
dba Jersey Shore Skilled Nursing and Rehabilitation Center
- Skilled Nursing Facility
- Jersey Shore, PA
- NPI 1063122778
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, Genesis PM PA Operations LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Grou
-
dba Quakertown Center
- Skilled Nursing Facility
- Quakertown, PA
- NPI 1588846893
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation
-
dba Chambersburg Skilled Nursing and Rehabilitation Center
- Skilled Nursing Facility
- Chambersburg, PA
- NPI 1780394494
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, Genesis PM PA Operations LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Grou
-
dba Chapel Manor
- Skilled Nursing Facility
- Philadelphia, PA
- NPI 1346422748
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation
-
dba Wallingford Borough Skilled Nursing and Rehabilitation Center
- Skilled Nursing Facility
- Wallingford, PA
- NPI 1417667130
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, Genesis PM PA Operations LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Grou
-
dba Hillcrest Center
- Skilled Nursing Facility
- Wyncote, PA
- NPI 1639351943
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Welltower Op, LLC, Zac
-
dba Laurel Center
- Skilled Nursing Facility
- Hamburg, PA
- NPI 1356523666
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation
-
dba Camp Hill Skilled Nursing and Rehabilitation Center
- Skilled Nursing Facility
- Camp Hill, PA
- NPI 1417667163
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, Genesis PM PA Operations LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Grou
-
dba Norriton Square Nursing and Rehabilitation Center
- Skilled Nursing Facility
- Norristown, PA
- NPI 1851573174
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Welltower Op, LLC, Zac
-
dba York North Skilled Nursing and Rehabilitation Center
- Skilled Nursing Facility
- York, PA
- NPI 1073223798
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, Genesis PM PA Operations LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Grou
-
dba York South Skilled Nursing and Rehabilitation Center
- Skilled Nursing Facility
- York, PA
- NPI 1326758046
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, Genesis PM PA Operations LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Grou
Practitioners & affiliated clinicians
Practitioners 3
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.
-
- Geriatric Medicine (Internal Medicine) Physician
- York, PA
- NPI 1497781686
-
- Geriatric Medicine (Family Medicine) Physician
- York, PA
- NPI 1881714855
-
- Geriatric Medicine (Internal Medicine) Physician
- Plymouth Meeting, PA
- NPI 1598788689
Affiliated clinicians 3
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Geriatric Medicine (Internal Medicine) Physician
- York, PA
- NPI 1497781686
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1670198400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1672963200000",
"number": "1336859040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 E STATE ST",
"city": "KENNETT SQUARE",
"state": "PA",
"postal_code": "193483109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 W QUEEN ST",
"city": "DALLASTOWN",
"state": "PA",
"postal_code": "173132133",
"telephone_number": "610-444-6350"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "100 W QUEEN STREET OPERATIONS LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "GENESIS PM PA OPERATIONS LLC",
"enumeration_date": "2022-12-05",
"last_updated": "2023-01-06",
"certification_date": "2023-01-06",
"status": "A",
"authorized_official_last_name": "BERG",
"authorized_official_first_name": "MICHAEL",
"authorized_official_title_or_position": "ASST SECRETARY",
"authorized_official_telephone_number": "505-468-4742"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCR",
"identifier": "39-5451",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "DALLASTOWN SKILLED NURSING AND REHABILITATION CENTER",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "DALLASTOWN SKILLED NURSING AND REHABILITATION CENTER",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Dallastown, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2023; 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.