Active NPI
Menorah Manor Inc
Doing business as Menorah Manor
- Skilled Nursing Facility
- St Petersburg, FL
National Provider Identifier
1548217060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- SNF1344096
- Legal business name
- MENORAH MANOR INC
- Doing business as
- Menorah Manor
- Practice address
- 255 59TH St N
St Petersburg, FL 33710 - Phone
- (727) 345-2775
- Fax
- (727) 344-8593
- NPI assigned
- May 29, 2006
- Last updated
- Jun 27, 2018
- 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
- Mrs. Donna Perryman, CPA
- Title
- Chief Financial Officer
- Phone
- (727) 302-3702
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | SNF1344096 | FL | Primary |
| Durable Medical Equipment & Medical Supplies | 332B00000X | 4037350001 | FL |
Addresses
Primary practice location
255 59TH St N
St Petersburg, FL 33710
Mailing address
255 59TH St N
St Petersburg, FL 33710-8539
Phone (727) 345-2775
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020844200 | Medicaid | FL |
Other names 1
- MENORAH MANOR
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080522000408 | FL | Part A Provider - Skilled Nursing Facility | 3173692779 | Practice locations: St Petersburg, FL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1548217060. Details of each certification follow.
Skilled nursing facility certification: CCN 105504
- Legal name
- MENORAH MANOR INC
- Doing business as
- MARION AND BERNARD L. SAMSON NURSING CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 1, 1985
- Last certification
- Mar 21, 2024
- Beds
- 180
- Ownership / control type
- Other Nonprofit
- Organization structure
- Other
- Incorporated
- Jun 30, 1981 in FL
- Enrollment address
- 255 59TH Street N
St Petersburg, FL 33710-8539 - Nursing home name
- MARION AND BERNARD L SAMSON NURSING CENTER
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Marion and Bernard L Samson Nursing Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Other
- Certified
- Jul 1, 1985
- Medicare certification status
- Active
- Certified beds
- 180
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D0667130 | Marion and Bernard L Samson Nursing Center | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider Directory- Tax ID family
- Irv Weissman Adult Day Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Irv Weissman Adult Day Center
- Adult Day Care Clinic/Center
- St Petersburg, FL
- NPI 1215394093
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Ownership & related parties
All disclosed owners & managing parties 5
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 |
|---|---|---|---|
| Donna Perryman | Corporate Officer | Dec 18, 2013 | 50% |
| Corporate Director | Oct 1, 2024 | 50% | |
| Operational/Managerial Control | Oct 1, 2024 | ||
| Managing Control - Governing Body | Jul 1, 1985 | ||
| Menorah Manor Inc | Trustee of the SNF | Jul 1, 1985 | |
| Robert Weisberg | Managing Control - Governing Body | Jul 1, 1985 | |
| Trustee of the SNF | Nov 1, 2010 | ||
| David a Levine | Operational/Managerial Control | Jul 1, 1995 | |
| Adp of the SNF | Mar 18, 2025 | ||
| Adp of the SNF | Mar 17, 2025 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Geriatric Medicine (Family Medicine) Physician
- St Petersburg, FL
- NPI 1114914249
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Affiliated clinicians 12
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Internal Medicine Physician
- St Petersburg, FL
- NPI 1144458977
Nursing home
-
- Geriatric Medicine (Internal Medicine) Physician
- St Petersburg, FL
- NPI 1871764977
Nursing home
-
- Geriatric Medicine (Family Medicine) Physician
- St Petersburg, FL
- NPI 1114914249
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148860800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1530057600000",
"number": "1548217060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "255 59TH ST N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337108539",
"telephone_number": "727-345-2775",
"fax_number": "727-344-8593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 59TH ST N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "33710",
"telephone_number": "727-345-2775",
"fax_number": "727-344-8593"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MENORAH MANOR INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-29",
"last_updated": "2018-06-27",
"status": "A",
"authorized_official_last_name": "PERRYMAN",
"authorized_official_first_name": "DONNA",
"authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
"authorized_official_telephone_number": "727-302-3702",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "CPA"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "FL",
"license": "SNF1344096",
"primary": true
},
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "FL",
"license": "4037350001",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "020844200",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "MENORAH MANOR",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; 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.