NPIMap

Organization Active NPI

Shady Grove SNF LLC

  • Skilled Nursing Facility
  • Rockville, MD
National Provider Identifier
1366931206
Registry record updated May 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SHADY GROVE SNF LLC
Practice address
9701 Medical Center Dr
Rockville, MD 20850-3326
Phone
(301) 315-1901
NPI assigned
May 7, 2018
Last updated
May 7, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2018

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

Authorized official

Name
Israel Birnbaum
Title
Authorized Official
Phone
(732) 905-6440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

9701 Medical Center Dr
Rockville, MD 20850-3326

Mailing address

9701 Medical Center Dr
Rockville, MD 20850-3326

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180823000617 MD Part A Provider - Skilled Nursing Facility 2769731876 Practice locations: Rockville, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366931206. Details of each certification follow.

Skilled nursing facility certification: CCN 215164

Legal name
SHADY GROVE SNF LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 5, 1987
Last certification
Mar 13, 2025
Beds
154
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Medical Facilities of America
Organization structure
LLCProprietary
Incorporated
Mar 23, 2018 in DE
Enrollment address
9701 Medical Center Dr
Rockville, MD 20850-3326
Nursing home name
SHADY GROVE NURSING AND REHABILITATION CENTER
Affiliated entity
LIFEWORKS REHAB

Care Compare: Nursing home

Medicare Care Compare
Listed as
Shady Grove Nursing and Rehabilitation CenterCCN 215164 · All quality measures
Overall star rating
2 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 5, 1987
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
154139.2 residents per day on average
Chain
Lifeworks Rehab64 facilities in the chain
Penalties (3 years)
1Fines totaling $8,278

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Shady Grove SNF LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

9701 Medical Center Dr
Rockville, MD 20850
Phone (301) 315-1900

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Rma Equity LLC Organization, Lakewood, NJ LLC 5% Or Greater Indirect Ownership Interest Jul 13, 2023 10%
Avrohom Y Kohn Individual 5% Or Greater Indirect Ownership InterestOwner Aug 1, 2018 10%
Israel M Birnbaum Individual 5% Or Greater Indirect Ownership InterestOwner May 1, 2021 36.84%
W-2 Managing Employee Aug 1, 2018
Michele Netzer Individual 5% Or Greater Indirect Ownership InterestOwner May 1, 2021 36.84%
Thunder Health Holdco LLC Organization, Lakewood, NJ LLC 5% Or Greater Direct Ownership Interest Jul 1, 2018 100%

Facilities with the same owner 3

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

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.

Affiliated clinicians 3

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": "1525651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525651200000",
    "number": "1366931206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9701 MEDICAL CENTER DR",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9701 MEDICAL CENTER DR",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503326",
            "telephone_number": "301-315-1901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY GROVE SNF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-07",
        "last_updated": "2018-05-07",
        "status": "A",
        "authorized_official_last_name": "BIRNBAUM",
        "authorized_official_first_name": "ISRAEL",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "732-905-6440"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

Verify at the official NPI Registry.