803 South Main Street Opco LLC
Organization Active NPI Skilled Nursing Facility · Woodstock, VA
NPI 1376351239 · NPPES record last updated Mar 10, 2025
Key facts
- NPI
- 1376351239
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- 803 SOUTH MAIN STREET OPCO LLC
- Practice address
- 803 S Main St
Woodstock, VA 22664-1125 - Phone
- (540) 459-5676
- Fax
- (540) 459-5490
- NPI assigned
- Dec 24, 2024
- Organization subpart
- No
Authorized official
- Name
- Tiffany Hoback
- Title
- Manager
- Phone
- (770) 698-9040
Owners & managing parties with NPI records 1
Facilities with the same owner 42
Affiliated clinicians 1
Medicare Care Compare: Nursing home
- Listed as
- Woodstock Valley Health and Rehabilitation
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★☆☆☆☆ 1 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Feb 17, 1997
- Medicare certification status
- Active
- Certified beds
- 88 · 70.3 residents per day on average
- Chain
- Avardis Health
- Special focus status
- SFF Candidate
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 3 · fines totaling $174,324
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D1015694 | 803 South Main Street Opco LLC | Certificate of waiver | Aug 11, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Skilled nursing facility certification: CCN 495315
- Legal name
- 803 SOUTH MAIN STREET OPCO LLC
- Doing business as
- WOODSTOCK VALLEY HEALTH AND REHABILITATION
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Feb 17, 1997
- Last certification
- May 23, 2024
- Beds
- 88
- Ownership / control type
- Corporation
- Multi-facility organization
- Consulate Health Care
- Most recent change of ownership
- Jun 1, 2025
- Organization structure
- LLC
- Enrollment address
- 803 S Main St
Woodstock, VA 22664-1125 - Nursing home name
- WOODSTOCK VALLEY HEALTH AND REHABILITATION
- Affiliated entity
- AVARDIS HEALTH
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Ahsan Afzal |
Operational/Managerial Control | Jun 1, 2025 | |
| Adp of the SNF | Jun 1, 2025 | ||
| |
Adp of the SNF | Apr 21, 2025 | |
| Nu C II Irrevocable Trust |
5% Or Greater Indirect Ownership Interest | May 1, 2025 | 50% |
| |
Adp of the SNF | Apr 21, 2025 | |
| Woodstock Parentco LLC |
5% Or Greater Direct Ownership Interest | May 1, 2025 | 100% |
| SNF Care Centers LLC |
5% Or Greater Indirect Ownership Interest | May 1, 2025 | 100% |
| Shenandoah Holdco LLC |
5% Or Greater Indirect Ownership Interest | May 1, 2025 | 100% |
| Alyssa L Clark |
Operational/Managerial Control | May 1, 2025 | |
| Managing Control - Governing Body | May 1, 2025 | ||
| Adp of the SNF | May 1, 2025 | ||
| SNF MGR LLC |
Operational/Managerial Control | May 1, 2025 | |
| Adp of the SNF | Apr 21, 2025 | ||
| |
Adp of the SNF | May 1, 2025 | |
| Vaop Holdco LLC |
5% Or Greater Indirect Ownership Interest | May 1, 2025 | 100% |
| Zenith Holdco II LLC |
5% Or Greater Indirect Ownership Interest | May 1, 2025 | 100% |
| Troy Snyder |
Operational/Managerial Control | Jan 5, 2026 | |
| Adp of the SNF | Jan 5, 2026 | ||
| |
Adp of the SNF | Apr 21, 2025 | |
| Tiffany Hoback |
Operational/Managerial Control | May 1, 2025 | |
| Managing Control - Governing Body | May 1, 2025 | ||
| Adp of the SNF | May 1, 2025 | ||
| Zenith Holdco LLC |
5% Or Greater Indirect Ownership Interest | May 1, 2025 | 100% |
| Tequilla Jones |
Operational/Managerial Control | May 1, 2025 | |
| Adp of the SNF | May 1, 2025 | ||
| Jessica Greenwalt |
Operational/Managerial Control | May 1, 2025 | |
| Adp of the SNF | May 1, 2025 | ||
| Nu C Irrevocable Trust |
5% Or Greater Indirect Ownership Interest | May 1, 2025 | 50% |
| |
Adp of the SNF | Apr 27, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250926003620 | VA | Part a Provider - Skilled Nursing Facility | 6002311289 | Practice locations: Woodstock, VA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
803 S Main St
Woodstock, VA 22664-1125
Mailing address
803 S Main St
Woodstock, VA 22664-1125
Phone (540) 459-5676
Other names
- Woodstock Valley Health & Rehabilitation
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service | Other | Synergy Healthcare Services |
Other providers in Woodstock, VA
- Ability Home Care
- Ability Home Care LLC
- Ability Home Care, LLC
- Leen Al-Faris
- Cheryl Renee Aldrich-Short
All providers in Woodstock, VA · Skilled Nursing Facility in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.