Edwardsville Operator, LLC
Organization Active NPI Skilled Nursing Facility · Edwardsville, KS
NPI 1487203444 · NPPES record last updated Sep 11, 2019
Key facts
- NPI
- 1487203444
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- EDWARDSVILLE OPERATOR, LLC
- Practice address
- 751 Blake St
Edwardsville, KS 66111-1338 - Phone
- (813) 441-1900
- NPI assigned
- Sep 11, 2019
- Organization subpart
- No
Authorized official
- Name
- Stuart Lindeman
- Title
- President and Ceo
- Phone
- (813) 280-1333
Facilities with the same owner 38
Practitioners 1
Affiliated clinicians 1
Medicare Care Compare: Nursing home
- Listed as
- Edwardsville Care and Rehab
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Apr 1, 1993
- Medicare certification status
- Active
- Certified beds
- 102 · 93.0 residents per day on average
- Chain
- Mission Health Communities
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 3 · fines totaling $38,753
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D0448893 | Edwardsville Operator, LLC | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Skilled nursing facility certification: CCN 175245
- Legal name
- EDWARDSVILLE OPERATOR LLC
- Doing business as
- EDWARDSVILLE CARE AND REHAB
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Apr 1, 1993
- Last certification
- Aug 21, 2024
- Beds
- 102
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Mission Health Communities
- Most recent change of ownership
- Oct 1, 2019
- Organization structure
- LLC · Proprietary
- Incorporated
- Jul 23, 2019 in FL
- Enrollment address
- 751 Blake St
Edwardsville, KS 66111-1338 - Nursing home name
- EDWARDSVILLE CARE AND REHAB
- Affiliated entity
- MISSION HEALTH COMMUNITIES
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Stuart D Lindeman |
Operational/Managerial Control |
Oct 1, 2019 | |
| Jamie Yoakum |
Corporate Officer |
Jan 19, 2024 | |
| Barres, LLC |
5% Or Greater Indirect Ownership Interest | Oct 1, 2019 | 5% |
| Mich 16 Edwardsville LLC |
Other | Apr 29, 2022 | |
| T and C Capital Assets, LLC |
5% Or Greater Indirect Ownership Interest | Oct 1, 2019 | 5% |
| Curis Holdings, LLC |
5% Or Greater Indirect Ownership Interest | Oct 1, 2019 | 100% |
| Coronado Operator, LLC |
5% Or Greater Direct Ownership Interest | Oct 1, 2019 | 100% |
| Mission Health Communities, LLC |
Operational/Managerial Control | Oct 1, 2019 | 100% |
| Windward Health Partners LLC |
5% Or Greater Indirect Ownership Interest | Oct 1, 2019 | 90% |
| Tina Thomas |
Operational/Managerial Control |
Oct 1, 2019 | |
| Edwardsville Operator LLC |
Operational/Managerial Control | Oct 1, 2019 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191029000668 | KS | Part a Provider - Skilled Nursing Facility | 9234461047 | Practice locations: Edwardsville, KS |
National Provider Directory
Locations
751 Blake St
Kansas City, KS 66111
Phone (405) 239-0261
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
751 Blake St
Edwardsville, KS 66111-1338
Mailing address
2907 W Bay to Bay Blvd Ste 303
Tampa, FL 33629-8187
Phone (813) 280-1333
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| N105004 | Other | KS | KANSAS STATE LICENSE NUMBER |
Other providers in Edwardsville, KS
- Marcia R Boal
- Melody A Chess
- City of Edwardsville KS
- Michelle Yvonne Cobler
- Edwardsville Care and Rehabilitation Center, LLC
- Michelle Ann Eickhoff
- Eps on Site Solutions
- Maria Herrera
- Kaw River Care and Rehabilitation Center, LLC
- Kaw River Operator, LLC
All providers in Edwardsville, KS · Skilled Nursing Facility in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2019. 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.