Active NPI
Embassy of East Mountain LLC
Doing business as Embassy of East Mountain
- Skilled Nursing Facility
- Wilkes Barre, PA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- EMBASSY OF EAST MOUNTAIN LLC
- Doing business as
- Embassy of East Mountain
- Practice address
- 101 E Mountain Blvd
Wilkes Barre, PA 18702-7911 - Phone
- (216) 378-2050
- NPI assigned
- Apr 4, 2024
- Last updated
- Apr 4, 2024
- 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
- Nicholas Ciccone
- Title
- Chief Compliance Officer
- Phone
- (216) 378-2050
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
101 E Mountain Blvd
Wilkes Barre, PA 18702-7911
Mailing address
25201 Chagrin Blvd Ste 190
Beachwood, OH 44122-5633
Other names 1
- Embassy of East Mountain
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240716004307 | PA | Part A Provider - Skilled Nursing Facility | 7416492269 | Practice locations: Wilkes Barre, PA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1407608128. Details of each certification follow.
Skilled nursing facility certification: CCN 395706
- Legal name
- EMBASSY OF EAST MOUNTAIN, LLC
- Doing business as
- EMBASSY OF EAST MOUNTAIN
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 18, 1985
- Last certification
- Mar 7, 2025
- Beds
- 120
- Ownership / control type
- Corporation
- Multi-facility organization
- Embassy Health Care Holding
- Organization structure
- LLC
- Enrollment address
- 101 E Mountain Blvd
Wilkes Barre, PA 18702-7911 - Nursing home name
- EMBASSY OF EAST MOUNTAIN
- Affiliated entity
- EMBASSY HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Embassy of East Mountain
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Oct 18, 1985
- Medicare certification status
- Active
- Certified beds
- 120
- Chain
- Embassy Healthcare
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 21
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 |
|---|---|---|---|
| Fillmore Strategic Investors LLC | Adp of the SNF | Jun 1, 2024 | |
| Ah Dynasty LLC | 5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 50% |
| Washington State Investment Board | Adp of the SNF | Jun 1, 2024 | |
| GPH Wilkes-Barre East Mountain LP | 5% Or Greater Security Interest | Jun 1, 2024 | 100% |
| Adp of the SNF | Jun 1, 2024 | ||
| Robb D McIlvried | Adp of the SNF | Apr 4, 2025 | |
| Drumm Merger Co | Adp of the SNF | Jun 1, 2024 | |
| Pearl Senior Care, LLC. | Adp of the SNF | Jun 1, 2024 | |
| Drumm Intermediary Sub Co LLC | Adp of the SNF | Jun 1, 2024 | |
| GSR Dynasty LLC | 5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 50% |
| Beverly Enterprises LLC | Adp of the SNF | Jun 1, 2024 | |
| George S. Repchick 2020 Family Dynasty Trust | 5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 50% |
| Aaron Handler Family Dynasty Trust | 5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 50% |
| Drumm Merger Co Sub LLC | Adp of the SNF | Jun 1, 2024 | |
| Beverly Enterprises - Pennsylvania, Inc. | Adp of the SNF | Jun 1, 2024 | |
| Beverly Health and Rehabilitiation Services, Inc | Adp of the SNF | Aug 1, 2024 | |
| Geary Property Holdings LLC | Adp of the SNF | Jun 1, 2024 | |
| Aaron B Handler | Operational/Managerial Control | Jun 1, 2024 | |
| George S. Repchick | Operational/Managerial Control | Jun 1, 2024 | |
| Lorree Levulis | Operational/Managerial Control | Jun 1, 2024 | |
| Adp of the SNF | Apr 4, 2025 | ||
| 2020 GSR Dynasty LLC | 5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 50% |
| Embassy Healthcare Holdings Inc | 5% Or Greater Direct Ownership Interest | Jun 1, 2024 | 100% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Geriatric Medicine (Internal Medicine) Physician
- Danville, PA
- NPI 1821050428
Adp of the SNF
Facilities with the same owner 31
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Delaware Valley Skilled Nursing & Rehabilitation Center
- Skilled Nursing Facility
- Matamoras, PA
- NPI 1043809577
2020 GSR Dynasty LLC, George S. Repchick 2020 Family Dynasty Trust
-
dba Embassy of Hearthside
- Skilled Nursing Facility
- State College, PA
- NPI 1467069005
2020 GSR Dynasty LLC, Aaron Handler Family Dynasty Trust, Ah Dynasty LLC, Embassy Healthcare Holdings Inc, George S. Repchick 2020 Family Dynasty Trust
-
dba Hermitage Nursing and Rehabilitation
- Skilled Nursing Facility
- Hermitage, PA
- NPI 1124648878
2020 GSR Dynasty LLC, Aaron Handler Family Dynasty Trust, Ah Dynasty LLC, Embassy Healthcare Holdings Inc, George S. Repchick 2020 Family Dynasty Trust
-
dba Embassy of Hillsdale Park
- Skilled Nursing Facility
- Hillsdale, PA
- NPI 1831796036
2020 GSR Dynasty LLC, Aaron Handler Family Dynasty Trust, Ah Dynasty LLC, Embassy Healthcare Holdings Inc, George S. Repchick 2020 Family Dynasty Trust
-
dba Embassy of Huntingdon Park
- Skilled Nursing Facility
- Huntingdon, PA
- NPI 1629685276
2020 GSR Dynasty LLC, Aaron Handler Family Dynasty Trust, Ah Dynasty LLC, Embassy Healthcare Holdings Inc, George S. Repchick 2020 Family Dynasty Trust
-
dba Embassy of Scranton
- Skilled Nursing Facility
- Scranton, PA
- NPI 1932951654
2020 GSR Dynasty LLC, Aaron Handler Family Dynasty Trust, Ah Dynasty LLC, Embassy Healthcare Holdings Inc, George S. Repchick 2020 Family Dynasty Trust
-
dba Embassy of Tunkhannock
- Skilled Nursing Facility
- Tunkhannock, PA
- NPI 1780436410
2020 GSR Dynasty LLC, Aaron Handler Family Dynasty Trust, Ah Dynasty LLC, Embassy Healthcare Holdings Inc, George S. Repchick 2020 Family Dynasty Trust
-
dba Embassy of Wyoming Valley
- Skilled Nursing Facility
- Wilkes Barre, PA
- NPI 1730931478
2020 GSR Dynasty LLC, Aaron Handler Family Dynasty Trust, Ah Dynasty LLC, Embassy Healthcare Holdings Inc, George S. Repchick 2020 Family Dynasty Trust
-
dba Embassy of Park Avenue
- Skilled Nursing Facility
- Meadville, PA
- NPI 1760099311
2020 GSR Dynasty LLC, Aaron Handler Family Dynasty Trust, Ah Dynasty LLC, Embassy Healthcare Holdings Inc, George S. Repchick 2020 Family Dynasty Trust
-
dba Embassy of Saxonburg
- Skilled Nursing Facility
- Saxonburg, PA
- NPI 1205596061
2020 GSR Dynasty LLC, Ah Dynasty LLC, Embassy Healthcare Holdings Inc
-
dba Clepper Manor
- Skilled Nursing Facility
- Sharon, PA
- NPI 1205456704
2020 GSR Dynasty LLC, Aaron Handler Family Dynasty Trust, Ah Dynasty LLC, Embassy Healthcare Holdings Inc, George S. Repchick 2020 Family Dynasty Trust
-
dba Embassy of Woodland Park
- Skilled Nursing Facility
- Orbisonia, PA
- NPI 1982211538
2020 GSR Dynasty LLC, Aaron Handler Family Dynasty Trust, Ah Dynasty LLC, Embassy Healthcare Holdings Inc, George S. Repchick 2020 Family Dynasty Trust
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
- Kingston, PA
- NPI 1750477139
-
- Geriatric Medicine (Internal Medicine) Physician
- Danville, PA
- NPI 1821050428
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Geriatric Medicine (Internal Medicine) Physician
- Danville, PA
- NPI 1821050428
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712188800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1712188800000",
"number": "1407608128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25201 CHAGRIN BLVD STE 190",
"city": "BEACHWOOD",
"state": "OH",
"postal_code": "441225633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 E MOUNTAIN BLVD",
"city": "WILKES BARRE",
"state": "PA",
"postal_code": "187027911",
"telephone_number": "216-378-2050"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EMBASSY OF EAST MOUNTAIN LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-04-04",
"last_updated": "2024-04-04",
"certification_date": "2024-04-04",
"status": "A",
"authorized_official_last_name": "CICCONE",
"authorized_official_first_name": "NICHOLAS",
"authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
"authorized_official_telephone_number": "216-378-2050"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Embassy of East Mountain",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Wilkes Barre, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; 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.