NPIMap

Organization Active NPI

Vantage at Wakefield LLC

  • Skilled Nursing Facility
  • Wakefield, MA
National Provider Identifier
1477328276
Registry record updated Nov 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
VANTAGE AT WAKEFIELD LLC
Practice address
1 Bathol St
Wakefield, MA 01880-3655
Phone
(781) 245-7600
NPI assigned
Nov 21, 2023
Last updated
Nov 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2023

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

Authorized official

Name
Sam Yurowitz
Title
Owner
Phone
(845) 558-2685

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1 Bathol St
Wakefield, MA 01880-3655

Mailing address

1 Bathol St
Wakefield, MA 01880-3655
Phone (781) 245-7600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240124003524 MA Part A Provider - Skilled Nursing Facility 1850744020 Practice locations: Wakefield, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477328276. Details of each certification follow.

Skilled nursing facility certification: CCN 225400A

Legal name
VANTAGE AT WAKEFIELD LLC
Doing business as
VANTAGE HEALTH & REHAB OF WAKEFIELD
Organization structure
LLCProprietary
Enrollment address
1 Bathol St
Wakefield, MA 01880-3655
Nursing home name
REGALCARE AT WAKEFIELD
Affiliated entity
VANTAGE CARE

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Miriam Tehilah Herskovitz Individual 5% Or Greater Indirect Ownership Interest Dec 1, 2023 21.25%
JPW Mass Holdings LLC Organization, Brooklyn, NY LLC 5% Or Greater Indirect Ownership Interest Dec 1, 2023 15%
Augustine Aiguosatile Individual W-2 Managing EmployeeAdministrator Dec 1, 2023
Cheryl Arem Individual 5% Or Greater Indirect Ownership Interest Dec 1, 2023 21.25%
Vivienne Yumasi Individual Corporate DirectorMedical Director Dec 1, 2023
Sam Yurowitz Individual 5% Or Greater Indirect Ownership Interest Dec 1, 2023 21.25%
Operational/Managerial ControlManager Dec 1, 2023
Yossi Brown Individual 5% Or Greater Indirect Ownership Interest Dec 1, 2023 21.25%
Vantage Care Ma4 LLC Organization, Wakefield, MA LLC 5% Or Greater Direct Ownership Interest Dec 1, 2023 100%

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 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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1700524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700524800000",
    "number": "1477328276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BATHOL ST",
            "city": "WAKEFIELD",
            "state": "MA",
            "postal_code": "018803655",
            "telephone_number": "781-245-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BATHOL ST",
            "city": "WAKEFIELD",
            "state": "MA",
            "postal_code": "018803655",
            "telephone_number": "781-245-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANTAGE AT WAKEFIELD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-21",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A",
        "authorized_official_last_name": "YUROWITZ",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "845-558-2685"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wakefield, MA

Sources for this page

Verify at the official NPI Registry.