1711 East Broad Street Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

1711 EAST BROAD STREET OPCO LLC

Doing business as

The Manor at St. Luke Village

Practice address

1711 E Broad St
Hazleton, PA 18201-5691

Phone

(570) 453-5100

Fax

(570) 453-5138

NPI assigned

Dec 24, 2024

Last updated

Mar 10, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tiffany Hoback

Title

Manager

Phone

(770) 698-9040

Specialties & licenses 1

Addresses

Other names 1

• The Manor at St. Luke Village Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356159206. Details of each certification follow.

• CCN 395636 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 395636

Legal name

1711 EAST BROAD STREET OPCO LLC

Doing business as

THE MANOR AT ST. LUKE VILLAGE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Apr 2, 1984

Last certification

Mar 28, 2025

Beds

104

Ownership / control type

Corporation

Multi-facility organization

Avardis

Organization structure

LLC

Enrollment address

1711 E Broad St
Hazleton, PA 18201-5691

Nursing home name

MANOR AT ST LUKE VILLAGE,THE

Affiliated entity

AVARDIS HEALTH

Listed as

Manor at St Luke Village,theCCN 395636 · All quality measures

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

3 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Apr 2, 1984

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

10493.0 residents per day on average

Chain

Avardis Health38 facilities in the chain

Penalties (3 years)

1Fines totaling $0

Processed by Care Compare on Aug 1, 2026.

Locations

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.

• Mark James Lobitz, D.O., CMD

  • Family Medicine Physician
  • Hazle Township, PA
  • NPI 1639141492

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 42

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• 1000 Stacie Drive Opco LLC

  dba The Pavilion at St. Luke Village

  • Skilled Nursing Facility
  • Hazleton, PA
  • NPI 1174331029

  Nu C II Irrevocable Trust, Nu C Irrevocable Trust, Paop Holdco LLC, SNF Care Centers LLC, SNF MGR LLC, Zenith Holdco II LLC, Zenith Holdco LLC

  CMS ownership
• 208 Pennknoll Road Opco LLC

  dba Pennknoll Village

  • Skilled Nursing Facility
  • Everett, PA
  • NPI 1710795661

  Nu C II Irrevocable Trust, Nu C Irrevocable Trust, Paop Holdco LLC, SNF Care Centers LLC, SNF MGR LLC, Zenith Holdco II LLC, Zenith Holdco LLC

  CMS ownership
• 51 Route 204 Opco LLC

  dba The Manor at Penn Village

  • Skilled Nursing Facility
  • Selinsgrove, PA
  • NPI 1629886684

  Nu C II Irrevocable Trust, Nu C Irrevocable Trust, Paop Holdco LLC, SNF Care Centers LLC, SNF MGR LLC, Zenith Holdco II LLC, Zenith Holdco LLC

  CMS ownership
• 69 Cottage Road Opco LLC

  dba Locust Grove Retirement Village

  • Skilled Nursing Facility
  • Mifflin, PA
  • NPI 1922816966

  Nu C II Irrevocable Trust, Nu C Irrevocable Trust, Paop Holdco LLC, SNF Care Centers LLC, SNF MGR LLC, Zenith Holdco II LLC, Zenith Holdco LLC

  CMS ownership
• 1000 Tandall Place Opco LLC

  dba Wellington Rehabilitation and Healthcare

  • Skilled Nursing Facility
  • Knightdale, NC
  • NPI 1790593648

  SNF MGR LLC

  CMS ownership
• 1001 Hospital Road Opco LLC

  dba Starkville Manor Health Care and Rehabilitation

  • Skilled Nursing Facility
  • Starkville, MS
  • NPI 1265240113

  SNF MGR LLC

  CMS ownership
• 101 Kirkland Street Opco LLC

  dba Hilltop Manor Health and Rehabilitation

  • Skilled Nursing Facility
  • Union, MS
  • NPI 1851109896

  SNF MGR LLC

  CMS ownership
• 1199 Ocean Springs Road Operations, LLC

  dba Ocean Springs Health and Rehabilitation Center

  • Skilled Nursing Facility
  • Ocean Springs, MS
  • NPI 1326795923

  SNF MGR LLC

  CMS ownership
• 12997 Nettles Drive Opco LLC

  dba Newport News Nursing and Rehabilitation

  • Skilled Nursing Facility
  • Newport News, VA
  • NPI 1477361418

  Nu C II Irrevocable Trust, Nu C Irrevocable Trust, SNF Care Centers LLC, SNF MGR LLC, Zenith Holdco II LLC, Zenith Holdco LLC

  CMS ownership
• 1304 Walnut Street Operations, LLC

  dba Pine View Health and Rehabilitation Center

  • Skilled Nursing Facility
  • Waynesboro, MS
  • NPI 1598412199

  SNF MGR LLC

  CMS ownership
• 1410 North Augusta Street Opco LLC

  dba King's Daughters Community Health and Rehabilitation

  • Skilled Nursing Facility
  • Staunton, VA
  • NPI 1487462420

  Nu C II Irrevocable Trust, Nu C Irrevocable Trust, SNF Care Centers LLC, Zenith Holdco II LLC, Zenith Holdco LLC

  CMS ownership
• 1530 Broad Avenue Operations, LLC

  dba Coastal Health and Rehabilitation Center

  • Skilled Nursing Facility
  • Gulfport, MS
  • NPI 1306593900

  SNF MGR LLC

  CMS ownership

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.

• Philip J. Benyo, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Sugarloaf, PA
  • NPI 1184622391
  NPD (past)
• Mark James Lobitz, D.O., CMD

  • Family Medicine Physician
  • Hazle Township, PA
  • NPI 1639141492
  NPD (past)
• Basant Kumar Mittal, M.D.

  • Internal Medicine Physician
  • Kingston, PA
  • NPI 1558427377
  NPD (past)

Affiliated clinicians 5

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

• Philip J. Benyo, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Sugarloaf, PA
  • NPI 1184622391

  Nursing home

  Care Compare affiliation
• Mark James Lobitz, D.O., CMD

  • Family Medicine Physician
  • Hazle Township, PA
  • NPI 1639141492

  Nursing home

  Care Compare affiliation
• Basant Kumar Mittal, M.D.

  • Internal Medicine Physician
  • Kingston, PA
  • NPI 1558427377

  Nursing home

  Care Compare affiliation
• Leocadia T Prawdzik, MD

  • Internal Medicine Physician
  • Hazleton, PA
  • NPI 1346218104

  Nursing home

  Care Compare affiliation
• Jude Francis Sidari, MD

  • Internal Medicine Physician
  • Hazleton, PA
  • NPI 1700825452

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1734998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741564800000",
    "number": "1356159206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 E BROAD ST",
            "city": "HAZLETON",
            "state": "PA",
            "postal_code": "182015691",
            "telephone_number": "570-453-5100",
            "fax_number": "570-453-5138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 E BROAD ST",
            "city": "HAZLETON",
            "state": "PA",
            "postal_code": "182015691",
            "telephone_number": "570-453-5100",
            "fax_number": "570-453-5138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1711 EAST BROAD STREET OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-24",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A",
        "authorized_official_last_name": "HOBACK",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-698-9040"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.5042",
            "affiliationName": "Synergy Healthcare Services",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "850 Concourse Pkwy S Ste 250",
            "city": "Maitland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327516155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The Manor at St. Luke Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 1000 Stacie Drive Opco LLC (The Pavilion at St. Luke Village)
• A Better Today, Inc.
• A Woman's Place OBGYN Associates PC
• Aaron North Inc
• Ashley Nicole Adams, CRNP
• Scott Joseph Adams, CRNP

• Skilled Nursing Facility in Hazleton, PA
• Providers in Hazleton, PA by specialty
• Skilled Nursing Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2025; 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.