Clearsky Rehabilitation Hospital of Lecanto, LLC
Organization Active NPI Rehabilitation Hospital · Lecanto, FL
NPI 1487380796 · NPPES record last updated Sep 14, 2022
Key facts
- NPI
- 1487380796
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rehabilitation Hospital 283X00000X
- Legal business name
- CLEARSKY REHABILITATION HOSPITAL OF LECANTO, LLC
- Practice address
- 3967 W Norvell Bryant Hwy
Lecanto, FL 34461 - Phone
- (352) 835-0819
- NPI assigned
- Jul 28, 2022
- Organization subpart
- No
Authorized official
- Name
- Kristi Duncan
- Title
- Cfo
- Phone
- (505) 317-3988
Facilities with the same owner 13
Affiliated clinicians 2
-
Nelson Mane, MD, DC
Medicare Care Compare: Inpatient rehabilitation facility
- Listed as
- Clearsky Rehabilitation Hospital of Lecanto
- Ownership
- For profit
- Certified
- Nov 14, 2023
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2286167 | Clearsky Rehabilitation Hospital of Lecanto LLC | Certificate of waiver | Jul 24, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Hospital certification: CCN 103061
- Legal name
- CLEARSKY REHABILITATION HOSPITAL OF LECANTO, LLC
- Certification status
- Active
- Provider type (POS)
- Hospital – Rehabilitation
- Participating since
- Nov 14, 2023
- Last certification
- Nov 14, 2023
- Beds
- 36
- Ownership / control type
- Private (for profit)
- Organization structure
- LLC · Proprietary
- Incorporated
- Feb 10, 2022 in DE
- Enrollment address
- 3967 W Norvell Bryant Hwy
Lecanto, FL 34461-9661 - Hospital subgroups
- Rehabilitation
All disclosed owners & managing parties 19
| Name | Role | Since | Share |
|---|---|---|---|
| BW Clearsky Aiv IV C Corp |
5% Or Greater Indirect Ownership Interest | Nov 17, 2023 | 9.45% |
| BW Clearsky Aiv IV Indirect Feeder LP |
5% Or Greater Indirect Ownership Interest | Nov 17, 2023 | 9.45% |
| BW Aiv IV Direct Feeder LP |
5% Or Greater Indirect Ownership Interest | Nov 17, 2023 | 35.21% |
| Peloton Clearsky Inc |
5% Or Greater Indirect Ownership Interest | Nov 17, 2023 | 44.66% |
| Glenn J Piche |
W-2 Managing Employee |
Jun 1, 2023 | |
| Kristi L Duncan |
Corporate Officer |
Feb 10, 2022 | |
| Peloton Clearsky LLC |
5% Or Greater Indirect Ownership Interest | Nov 17, 2023 | 22.33% |
| Peloton Equity II LP |
5% Or Greater Indirect Ownership Interest | Nov 17, 2023 | 22.33% |
| Claude Darby Brockette |
Corporate Officer |
Feb 10, 2022 | |
| Sheryl H Gentile |
Corporate Officer |
Feb 10, 2022 | |
| Clearsky Health Acquisition LLC |
5% Or Greater Direct Ownership Interest | Feb 10, 2022 | 100% |
| Leavitt Equity Partners II LP |
5% Or Greater Indirect Ownership Interest | Nov 17, 2023 | 5.95% |
| Michael J Warrington |
Corporate Officer |
Dec 2, 2024 | |
| Clearsky Health Intermediate LLC |
5% Or Greater Indirect Ownership Interest | Feb 10, 2022 | 100% |
| Clearsky Employee Holdings-a, LLC |
5% Or Greater Indirect Ownership Interest | Nov 17, 2023 | 4.74% |
| Clearsky Health Holdings LLC |
5% Or Greater Indirect Ownership Interest | Feb 10, 2022 | 100% |
| Theodore B Lundberg |
Corporate Officer |
Feb 10, 2022 | |
| Jeremy Michael Kogler |
Corporate Officer |
Feb 10, 2022 | |
| BW Clearsky Aiv IV LP |
5% Or Greater Indirect Ownership Interest | Nov 17, 2023 | 44.66% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230508000032 | FL | Part a Provider - Hospital | 4981069382 | Practice locations: Lecanto, FL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Hospital | 283X00000X | Yes |
Addresses
Primary practice location
3967 W Norvell Bryant Hwy
Lecanto, FL 34461
Mailing address
5600 Wyoming Blvd NE Ste 225
Albuquerque, NM 87109-3136
Phone (505) 317-3802
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All providers in Lecanto, FL · Rehabilitation Hospital in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2022. 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.