NPIMap

Organization Active NPI

Spring Lake NC, LLC

  • Skilled Nursing Facility
  • Winter Haven, FL
National Provider Identifier
1366439952
Registry record updated Jul 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
SNF15110961 Issued in FL
Legal business name
SPRING LAKE NC, LLC
Practice address
1540 6TH St NW
Winter Haven, FL 33881-2368
Phone
(863) 294-3055
Fax
(863) 294-4210
NPI assigned
Sep 29, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2014

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

Authorized official

Name
Mr. Samuel B. Kellett
Title
As Sole Member of SBK Capital LLC
Phone
(404) 233-7048

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X SNF15110961 FL Primary

Addresses

Primary practice location

1540 6TH St NW
Winter Haven, FL 33881-2368

Mailing address

1540 6TH St NW
Winter Haven, FL 33881-2368
Phone (863) 294-3055

Other identifiers 2

IdentifierTypeStateIssuer
026457100MedicaidFL
V673P-5338OtherVA

Other names 1

  • Spring Lake Rehabilitation Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031125000329 FL Part A Provider - Skilled Nursing Facility 2668385352 Practice locations: Winter Haven, FL

Skilled nursing facility certification: CCN 105730

Legal name
SPRING LAKE NC, LLC
Doing business as
SPRING LAKE REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
May 17, 1991
Last certification
Feb 13, 2025
Beds
132
Ownership / control type
Partnership
Most recent change of ownership
Dec 1, 2003
Organization structure
LLCProprietary
Enrollment address
1540 6TH St NW
Winter Haven, FL 33881-2368
Nursing home name
SPRING LAKE REHABILITATION CENTER
Affiliated entity
CLEAR CHOICE HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Spring Lake Rehabilitation CenterCCN 105730
Overall star rating
5 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Partnership
Certified
May 17, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
132128.4 residents per day on average
Chain
Clear Choice Healthcare8 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Spring Lake NC LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Capital Funding Group, LLC Organization, Baltimore, MD LLC, Financial institution, For-profit, Owned by another organization or individual 5% Or Greater Mortgage Interest Apr 9, 2019 66%
Edward R Bonner Individual Operational/Managerial Control May 12, 2025
Adp of the SNF Oct 30, 2025
Deborah P Kennedy Individual Operational/Managerial Control Dec 1, 2003
SBK Capital, LLC Organization, Canton, GA LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Dec 1, 2003 99%
Operational/Managerial Control Dec 1, 2003
Clear Choice Health Care LLC Organization, Melbourne, FL LLC, For-profit Operational/Managerial Control Oct 1, 2007
Leslie R Partee Individual Operational/Managerial Control Dec 1, 2022
Claudio F Manubens Individual Operational/Managerial Control Feb 9, 2018
Adp of the SNF Oct 30, 2025
Samuel B Kellet Qtip MRTL TR Organization, Canton, GA LLC, For-profit, Owned by another organization or individual Direct Ownership Interest Dec 1, 2003 1%

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 10

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

Practitioners & affiliated clinicians

Affiliated clinicians 12

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": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406592000000",
    "number": "1366439952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 6TH ST NW",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338812368",
            "telephone_number": "863-294-3055",
            "fax_number": "863-294-4210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 6TH ST NW",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338812368",
            "telephone_number": "863-294-3055",
            "fax_number": "863-294-4210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRING LAKE NC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2014-07-29",
        "status": "A",
        "authorized_official_last_name": "KELLETT",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "AS SOLE MEMBER OF SBK CAPITAL LLC",
        "authorized_official_telephone_number": "404-233-7048",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF15110961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026457100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA",
            "identifier": "V673P-5338",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spring Lake Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winter Haven, FL

Sources for this page

Verify at the official NPI Registry.