Active NPI
Park Center Nursing LLC
- Skilled Nursing Facility
- Youngstown, OH
National Provider Identifier
1407444359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- PARK CENTER NURSING LLC
- Practice address
- 5665 South Ave
Youngstown, OH 44512-2459 - Phone
- (330) 782-1173
- NPI assigned
- Jan 6, 2021
- Last updated
- Jan 7, 2021
- 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
- Joseph Charles
- Title
- Member
- Phone
- (330) 782-1173
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
5665 South Ave
Youngstown, OH 44512-2459
Mailing address
5665 South Ave
Youngstown, OH 44512-2459
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210318002010 | OH | Part A Provider - Skilled Nursing Facility | 7214344266 | Practice locations: Youngstown, OH |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1407444359. Details of each certification follow.
Skilled nursing facility certification: CCN 365185
- Legal name
- PARK CENTER NURSING LLC
- Doing business as
- PARK CENTER HEALTHCARE AND REHABILITATION
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Apr 1, 1973
- Last certification
- Apr 29, 2024
- Beds
- 99
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Incorporated
- Jan 6, 2021 in OH
- Enrollment address
- 5665 South Avenue
Youngstown, OH 44512-2459 - Nursing home name
- PARK CENTER HEALTHCARE AND REHABILITATION
- Affiliated entity
- DAVID OBERLANDER
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Park Center Healthcare and Rehabilitation
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Apr 1, 1973
- Medicare certification status
- Active
- Certified beds
- 99
- Chain
- David Oberlander
- Penalties (3 years)
- 1
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 6
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 |
|---|---|---|---|
| Park Cernter Holdings LLC | 5% Or Greater Direct Ownership Interest | Mar 8, 2021 | 100% |
| Park Center Opco LLC | 5% Or Greater Indirect Ownership Interest | Mar 8, 2021 | 76% |
| Adp of the SNF | May 1, 2021 | ||
| Fuego LLC | Operational/Managerial Control | May 1, 2021 | |
| David Oberlander | 5% Or Greater Direct Ownership Interest | Mar 8, 2021 | 24% |
| Operational/Managerial Control | Mar 8, 2021 | ||
| Brian McClain | Adp of the SNF | Mar 13, 2025 | |
| Cecelia Trevino | Adp of the SNF | Mar 5, 2025 |
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 1
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.
-
- Internal Medicine Physician
- Canton, OH
- NPI 1821038043
-
- Internal Medicine Physician
- Youngstown, OH
- NPI 1437153830
-
- Internal Medicine Physician
- Beachwood, OH
- NPI 1225011836
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": "1609891200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1609977600000",
"number": "1407444359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5665 SOUTH AVE",
"city": "YOUNGSTOWN",
"state": "OH",
"postal_code": "445122459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5665 SOUTH AVE",
"city": "YOUNGSTOWN",
"state": "OH",
"postal_code": "445122459",
"telephone_number": "330-782-1173"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PARK CENTER NURSING LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-01-06",
"last_updated": "2021-01-07",
"certification_date": "2021-01-07",
"status": "A",
"authorized_official_last_name": "CHARLES",
"authorized_official_first_name": "JOSEPH",
"authorized_official_title_or_position": "MEMBER",
"authorized_official_telephone_number": "330-782-1173"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Youngstown, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2021; 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.