Laurellwood FL Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LAURELLWOOD FL OPCO LLC

Practice address

3127 57TH Ave N
St Petersburg, FL 33714-1320

Phone

(727) 527-2171

NPI assigned

Mar 18, 2022

Last updated

May 16, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Herskowitz

Title

Chief of Staff

Phone

(212) 444-1991

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1538818521. Details of each certification follow.

• CCN 105228 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 105228

Legal name

LAURELLWOOD FL OPCO LLC

Doing business as

LAURELLWOOD POST-ACUTE AND REHABILITATION CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Mar 1, 1979

Last certification

Sep 13, 2023

Beds

60

Ownership / control type

Limited Liability Corporation

Multi-facility organization

Vivo Healthcare

Organization structure

LLCProprietary

Enrollment address

3127 57TH Ave N
St Petersburg, FL 33714-1320

Listed as

Vivo Healthcare LaurellwoodCCN 105228 · All quality measures

Overall star rating

3 of 5

Health inspections

2 of 5

Staffing

3 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Mar 1, 1979

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

6049.2 residents per day on average

Penalties (3 years)

1Fines totaling $37,316

Processed by Care Compare on Aug 1, 2026.

Locations

Networks

• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

All disclosed owners & managing parties 6

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Luis F Ycaza, D.O.

  • Internal Medicine Physician
  • St Petersburg, FL
  • NPI 1366480311

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Karina Torres, MD

  • Internal Medicine Physician
  • St Petersburg, FL
  • NPI 1881221877

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1647561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684195200000",
    "number": "1538818521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23645 MERCANTILE RD STE J",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225936",
            "telephone_number": "212-444-1991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3127 57TH AVE N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337141320",
            "telephone_number": "727-527-2171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAURELLWOOD FL OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-18",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "HERSKOWITZ",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CHIEF OF STAFF",
        "authorized_official_telephone_number": "212-444-1991"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.