Active NPI
J2112, LLC
- Skilled Nursing Facility
- Seminole, FL
National Provider Identifier
1538884259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- J2112, LLC
- Practice address
- 11300 110TH Ave
Seminole, FL 33778-3711 - Phone
- (727) 391-9986
- NPI assigned
- Oct 5, 2022
- Last updated
- Oct 5, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kevin Ryan Rockefeller
- Title
- Manager
- Phone
- (904) 422-5231
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
11300 110TH Ave
Seminole, FL 33778-3711
Mailing address
200 Clearwater Largo Rd S
Largo, FL 33770-3235
Phone (727) 489-0857
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230816003703 | FL | Part A Provider - Skilled Nursing Facility | 4183086556 | Practice locations: Seminole, FL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1538884259. Details of each certification follow.
Skilled nursing facility certification: CCN 105849
- Legal name
- J2112 LLC
- Doing business as
- WRIGHT'S HEALTHCARE & REHABILITATION CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Dec 16, 1993
- Last certification
- Sep 20, 2023
- Beds
- 60
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Incorporated
- Sep 15, 2022 in FL
- Enrollment address
- 11300 110TH Ave N
Seminole, FL 33778 - Nursing home name
- WRIGHTS HEALTHCARE AND REHABILITATION CENTER
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Wrights Healthcare and Rehabilitation Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Dec 16, 1993
- Medicare certification status
- Active
- Certified beds
- 60
- Penalties (3 years)
- 1
National Provider Directory
National Provider DirectoryNetworks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Ownership & related parties
All disclosed owners & managing parties 3
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Daniel Hollenbeck | 5% Or Greater Direct Ownership Interest | Sep 25, 2022 | 20% |
| Kevin Rockefeller | 5% Or Greater Direct Ownership Interest | Sep 15, 2022 | 60% |
| Brad Graham | 5% Or Greater Direct Ownership Interest | Sep 15, 2022 | 20% |
| Operational/Managerial Control | Mar 1, 2023 | 100% |
Practitioners & affiliated clinicians
Affiliated clinicians 1
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": "1664928000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1664928000000",
"number": "1538884259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 CLEARWATER LARGO RD S",
"city": "LARGO",
"state": "FL",
"postal_code": "337703235",
"telephone_number": "727-489-0857"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11300 110TH AVE",
"city": "SEMINOLE",
"state": "FL",
"postal_code": "337783711",
"telephone_number": "727-391-9986"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "J2112, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-10-05",
"last_updated": "2022-10-05",
"certification_date": "2022-10-05",
"status": "A",
"authorized_official_last_name": "ROCKEFELLER",
"authorized_official_first_name": "KEVIN",
"authorized_official_middle_name": "RYAN",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "904-422-5231"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seminole, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; 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.