Blumenthal Operator LLC
Organization Active NPI Skilled Nursing Facility · Greensboro, NC
NPI 1417708652 · NPPES record last updated Jul 10, 2024
Key facts
- NPI
- 1417708652
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- BLUMENTHAL OPERATOR LLC
- Practice address
- 3724 Wireless Dr
Greensboro, NC 27455-3312 - Phone
- (336) 540-9991
- NPI assigned
- Mar 27, 2024
- Organization subpart
- No
Authorized official
- Name
- Craig Neiswanger
- Title
- Authorized Agent
- Phone
- (336) 540-9991
Owners & managing parties with NPI records 3
-
Tasrif Ahmed, M.D.
-
Christopher Johnson, DPT
-
Julius Chamberlain Shayo, NP-C
Facilities with the same owner 5
Affiliated clinicians 1
-
Tasrif Ahmed, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Blumenthal Health and Rehabilitation Center
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jan 1, 1967
- Medicare certification status
- Active
- Certified beds
- 134 · 111.2 residents per day on average
- Chain
- Lifeworks Rehab
- Special focus status
- SFF
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 5 · fines totaling $210,325
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D0237011 | Blumenthal Health and Rehabilitation Center | Certificate of waiver | Dec 8, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Skilled nursing facility certification: CCN 345006
- Legal name
- BLUMENTHAL OPERATOR LLC
- Doing business as
- BLUMENTHAL HEALTH AND REHABILITATION CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 1967
- Last certification
- Nov 1, 2024
- Beds
- 134
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Medical Facilities of America
- Organization structure
- LLC · Proprietary
- Enrollment address
- 3724 Wireless Drive
Greensboro, NC 27455-3312 - Nursing home name
- BLUMENTHAL HEALTH AND REHABILITATION CENTER
- Affiliated entity
- LIFEWORKS REHAB
All disclosed owners & managing parties 41
| Name | Role | Since | Share |
|---|---|---|---|
| Ib Mimi 2022 Family Trust |
5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 22.13% |
| Adp of the SNF | Jun 1, 2024 | ||
| 3724 Wireless Drive LLC |
Adp of the SNF | Jun 1, 2024 | |
| Hillel D Weiss |
Trustee of the SNF | Jun 1, 2024 | |
| ML Milano 2022 Family Trust |
5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 22.13% |
| Jada James |
Corporate Officer | Jun 1, 2024 | |
| JK 2022 Grantor Family Trust |
5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 23.28% |
| Travisha Kelley |
Corporate Officer | Jun 1, 2024 | |
| Milano Family Holdings LLC |
5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 23.28% |
| Will Family 2016 Trust |
5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 4.9% |
| Moss M Ellenbogen |
Trustee of the SNF | Jun 1, 2024 | |
| Christopher Michael Johnson |
Corporate Officer | Jun 1, 2024 | |
| Cyop Cyber Security LLC |
Adp of the SNF | Jun 1, 2024 | |
| Healthcare Services Group Inc |
Adp of the SNF | Jun 1, 2024 | |
| Brooke Mustain |
Corporate Officer | Jun 1, 2024 | |
| TJ Family Trust |
5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 9.31% |
| ML Milano 2022 Family Grantor Trust |
5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 1.14% |
| Horace Wilson |
Managing Control - Governing Body |
Jun 1, 2024 | |
| Vera Shaw |
Corporate Officer | Jun 1, 2025 | |
| Cindy Maher |
Operational/Managerial Control | Jun 1, 2024 | |
| Uh Carolina SNF Operations Holdings LLC |
5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 100% |
| Lasaro Cruz |
Operational/Managerial Control | Jun 1, 2024 | |
| Adp of the SNF | Jun 1, 2024 | ||
| Live Well Plus LLC |
Adp of the SNF | Jun 1, 2024 | |
| Noah Burton |
Trustee of the SNF | Jun 1, 2024 | |
| Catherine Rodriguez |
Corporate Officer | Jun 1, 2024 | |
| Medical Facilities of America Administrative Consulting Services LLC |
Adp of the SNF | Jun 1, 2024 | |
| Acs Pro Global Solutions |
Adp of the SNF | Jun 1, 2024 | |
| Tasrif Ahmed |
Adp of the SNF | Oct 8, 2025 | |
| Universal Operations Holdings LLC |
5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 69.82% |
| Digacore Consulting |
Adp of the SNF | Jun 1, 2024 | |
| Megan Summer |
Corporate Officer | Jun 1, 2024 | |
| Blumenthal Holdings LLC |
5% Or Greater Direct Ownership Interest | Jun 1, 2024 | 100% |
| Turning Point Consulting LLC |
Adp of the SNF | Jun 1, 2024 | |
| Bridgewater NC Holdings LLC |
5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 23.28% |
| Ib Mimi 2022 Family Grantor Trust |
5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 1.14% |
| Trustee of the SNF | Jun 1, 2024 | ||
| Adp of the SNF | Oct 8, 2025 | ||
| Tol Opco Investco LLC |
5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 23.28% |
| Rhonda Draper |
Corporate Officer | Jun 1, 2024 | |
| HL Family Trust |
5% Or Greater Indirect Ownership Interest | Jun 1, 2024 | 9.31% |
| Mfa Clinical Consulting LLC |
Adp of the SNF | Jun 1, 2024 | |
| Medline Industries |
Adp of the SNF | Jun 1, 2024 | |
| Julius Chamberlain Shayo |
Corporate Officer | Jun 1, 2024 | |
| Mfa Heritage Consulting LLC |
Adp of the SNF | Jun 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241107003975 | NC | Part a Provider - Skilled Nursing Facility | 9638603079 | Practice locations: Greensboro, NC |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
3724 Wireless Dr
Greensboro, NC 27455-3312
Mailing address
3724 Wireless Dr
Greensboro, NC 27455-3312
Phone (336) 540-9991
Other names
- Blumenthal Health and Rehabilitation Center
Other providers in Greensboro, NC
- Blue Ridge Health Services
- Blue Skies Health Care, Inc.
- Brittany P Blue
- Soijett Alantra Blue
- Blueprint Technologies, Inc
- Graham Davis Blust
- Maria Barton Blust
- Brittni Nicole Bly
- Melanie McNeely Boatwright
- Karen M. Flesner Bobalik
All providers in Greensboro, NC · Skilled Nursing Facility in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2024. 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.