Active NPI
1543 Country Club Road Manor Operations LLC
Doing business as Pierpont Center at Fairmont Campus
- Skilled Nursing Facility
- Fairmont, WV
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 59
- Legal business name
- 1543 COUNTRY CLUB ROAD MANOR OPERATIONS LLC
- Doing business as
- Pierpont Center at Fairmont Campus
- Practice address
- 1543 Country Club Rd
Fairmont, WV 26554-1306 - Phone
- (304) 363-2273
- NPI assigned
- Dec 30, 2008
- Last updated
- Jul 9, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael T Berg
- Title
- Secretary
- Phone
- (610) 444-6350
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 59 | WV | Primary |
Addresses
Primary practice location
1543 Country Club Rd
Fairmont, WV 26554-1306
Mailing address
101 E State St
Kennett Square, PA 19348-3109
Phone (610) 925-4436
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810013993 | Medicaid | WV |
Other names 1
- Pierpont Center at Fairmont Campus
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090206000413 | WV | Part A Provider - Skilled Nursing Facility | 4385709385 | Practice locations: Fairmont, WV |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1396981064. Details of each certification follow.
Skilled nursing facility certification: CCN 515155
- Legal name
- 1543 COUNTRY CLUB ROAD MANOR OPERATIONS LLC
- Doing business as
- PIERPONT CENTER AT FAIRMONT CAMPUS
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- May 14, 1997
- Last certification
- Mar 13, 2024
- Beds
- 120
- Ownership / control type
- Corporation
- Multi-facility organization
- Genesis
- Organization structure
- LLC
- Incorporated
- Dec 18, 2008 in WV
- Enrollment address
- 1543 Country Club Road
Fairmont, WV 26554-1306 - Nursing home name
- PIERPONT CENTER AT FAIRMONT CAMPUS
- Affiliated entity
- GENESIS HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Pierpont Center at Fairmont Campus
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- May 14, 1997
- Medicare certification status
- Active
- Certified beds
- 120
- Chain
- Genesis Healthcare
- Penalties (3 years)
- 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 51D0661850 | Pierpont Center at Fairmont Campus | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider Directory- Tax ID family
- 1543 Country Club Road Manor Operations LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Wishing Well Assisted Living Community at Fairmont Campus
- Assisted Living Facility
- Fairmont, WV
- NPI 1942446745
Ownership & related parties
All disclosed owners & managing parties 22
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 |
|---|---|---|---|
| Genesis Omg Operations LLC | 5% Or Greater Direct Ownership Interest | Jan 1, 2012 | 100% |
| Laura Bridgeford | Corporate Officer | Jan 1, 2019 | 100% |
| HCCF Management Group XI LLC | 5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 10.8% |
| Gen Operations I LLC | 5% Or Greater Indirect Ownership Interest | Jan 1, 2012 | 100% |
| Gen Operations II LLC | 5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| Diane Louise Morris | Operational/Managerial Control | Jan 1, 2022 | |
| Adp of the SNF | Jan 1, 2022 | ||
| FC-Gen Operations Investment LLC | 5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| Kristin Reed | Operational/Managerial Control | Apr 25, 2022 | |
| Adp of the SNF | Mar 26, 2025 | ||
| Genesis Healthcare LLC | 5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| Zaveen a Kureishy | Operational/Managerial Control | Mar 2, 2025 | |
| Adp of the SNF | Mar 26, 2025 | ||
| Sun Healthcare Group Inc | 5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 65.3% |
| Welltower Op, LLC | 5% Or Greater Indirect Ownership Interest | Apr 20, 2020 | 7.6% |
| Adp of the SNF | Mar 26, 2025 | ||
| Arnold M Whitman | 5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 10.8% |
| Genesis Healthcare Inc | 5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| Zac Properties XI LLC | 5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 7.6% |
| Steven E Fishman | 5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 7.6% |
| Avi Pinchas Mendelson | Corporate Officer | Jun 1, 2024 | 100% |
| Michael T Berg | Corporate Officer | Mar 2, 2015 | 100% |
| Adp of the SNF | Mar 26, 2025 | ||
| GHC Holdings LLC | 5% Or Greater Indirect Ownership Interest | Jan 1, 2012 | 100% |
| Genesis Holdings LLC | 5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Glen Dale, WV
- NPI 1467455915
Adp of the SNF, Operational/Managerial Control
Facilities with the same owner 178
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Marmet Center
- Skilled Nursing Facility
- Marmet, WV
- NPI 1538343710
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 Valley Center
- Skilled Nursing Facility
- South Charleston, WV
- NPI 1558545749
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 Heritage Center
- Skilled Nursing Facility
- Huntington, WV
- NPI 1912181223
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 Ansted Center
- Skilled Nursing Facility
- Ansted, WV
- NPI 1639353816
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 Tygart Center at Fairmount Campus
- Skilled Nursing Facility
- Fairmont, WV
- NPI 1578709341
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, Genesis Omg Operations LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group
-
dba Madison Center
- Skilled Nursing Facility
- Morgantown, WV
- NPI 1073797387
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 Raleigh Center
- Skilled Nursing Facility
- Daniels, WV
- NPI 1063696243
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, Zac Properties XI LLC
-
dba Ravenswood Village
- Skilled Nursing Facility
- Ravenswood, WV
- NPI 1124202304
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 Sistersville Center
- Skilled Nursing Facility
- Sistersville, WV
- NPI 1831373026
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 Care Haven Center
- Skilled Nursing Facility
- Martinsburg, WV
- NPI 1053595355
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 Properties XI LLC
-
dba Cedar Ridge Center
- Skilled Nursing Facility
- Sissonville, WV
- NPI 1689858987
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 Pine View Center
- Skilled Nursing Facility
- Harrisville, WV
- NPI 1982484671
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
Practitioners & affiliated clinicians
Practitioners 2
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.
-
- Internal Medicine Physician
- Morgantown, WV
- NPI 1376515692
-
- Internal Medicine Physician
- Morgantown, WV
- NPI 1568099513
Affiliated clinicians 2
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": "1230595200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1752019200000",
"number": "1396981064",
"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",
"telephone_number": "610-925-4436",
"fax_number": "610-347-4099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1543 COUNTRY CLUB RD",
"city": "FAIRMONT",
"state": "WV",
"postal_code": "265541306",
"telephone_number": "304-363-2273"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "1543 COUNTRY CLUB ROAD MANOR OPERATIONS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-12-30",
"last_updated": "2025-07-09",
"certification_date": "2025-07-09",
"status": "A",
"authorized_official_last_name": "BERG",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "SECRETARY",
"authorized_official_telephone_number": "610-444-6350"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "WV",
"license": "59",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810013993",
"state": "WV"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Pierpont Center at Fairmont Campus",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fairmont, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.