NPIMap

Organization Active NPI

Port St Joe Opco LLC

  • Skilled Nursing Facility
  • Port St Joe, FL
National Provider Identifier
1427834290
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PORT ST JOE OPCO LLC
Practice address
220 9TH St
Port St Joe, FL 32456-1924
Phone
(718) 916-1443
NPI assigned
Sep 6, 2023
Last updated
Sep 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joe Neuman
Title
Authorized Member
Phone
(718) 916-1443

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

220 9TH St
Port St Joe, FL 32456-1924

Mailing address

144 Shady Lane Dr
Lakewood, NJ 08701-2351
Phone (732) 364-2444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241220000476 FL Part A Provider - Skilled Nursing Facility 6709233901 Practice locations: Port Saint Joe, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427834290. Details of each certification follow.

Skilled nursing facility certification: CCN 105435

Legal name
PORT ST JOE OPCO LLC
Doing business as
SHORES NURSING AND REHAB CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 15, 1983
Last certification
Feb 2, 2024
Beds
120
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
220 9TH St
Port Saint Joe, FL 32456-1924
Nursing home name
SHORES NURSING AND REHAB CENTER
Affiliated entity
ELIYAHU MIRLIS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Shores Nursing and Rehab CenterCCN 105435 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 15, 1983
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12098.8 residents per day on average
Chain
Eliyahu Mirlis13 facilities in the chain
Special focus status
SFF Candidate
Penalties (3 years)
1Fines totaling $137,446

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Sarah Becher Individual 5% Or Greater Indirect Ownership Interest Aug 1, 2023 1%
220 Ninth St Port St Joe Holdco LLC Organization, Lakewood, NJ Created for acquisition, LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 1, 2024 100%
VRD 10 Hldco LLC Organization, Lakewood, NJ LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 1, 2023 100%
Eliyahu Mirlis Individual 5% Or Greater Indirect Ownership Interest Aug 1, 2023 99%
Corporate OfficerBusiness Manager Aug 1, 2023 100%
Jack D Harrison Individual Operational/Managerial Control Dec 31, 2024
Adp of the SNF Dec 31, 2024
Daniel Thorngren III Individual Operational/Managerial Control Dec 31, 2024
Adp of the SNF Dec 31, 2024
New Horizon Healthcare LLC Organization, Lakewood, NJ Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 1, 2023 35%

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 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

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": "1693958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1427834290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 SHADY LANE DR",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087012351",
            "telephone_number": "732-364-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 9TH ST",
            "city": "PORT ST JOE",
            "state": "FL",
            "postal_code": "324561924",
            "telephone_number": "718-916-1443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT ST JOE OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-06",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "NEUMAN",
        "authorized_official_first_name": "JOE",
        "authorized_official_title_or_position": "AUTHORIZED MEMBER",
        "authorized_official_telephone_number": "718-916-1443"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Joe, FL

Sources for this page

Verify at the official NPI Registry.