NPIMap

Organization Active NPI

Warren Mi Opco LLC

  • Skilled Nursing Facility
  • Warren, MI
National Provider Identifier
1558033175
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WARREN MI OPCO LLC
Practice address
12250 E 12 Mile Rd
Warren, MI 48093-3516
Phone
(718) 838-1501
NPI assigned
Oct 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Authorized official

Name
Rob Korn
Title
Manager
Phone
(718) 838-1501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

12250 E 12 Mile Rd
Warren, MI 48093-3516

Mailing address

362 E Kennedy Blvd
Lakewood, NJ 08701-1434

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220623000262 MI Part A Provider - Skilled Nursing Facility 2163801010 Practice locations: Warren, MI

Skilled nursing facility certification: CCN 235509

Legal name
WARREN MI OPCO LLC
Doing business as
THE ORCHARDS AT WARREN
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 30, 1991
Last certification
Sep 19, 2024
Beds
134
Ownership / control type
Corporation
Multi-facility organization
The Orchards
Organization structure
LLCProprietary
Incorporated
Jul 20, 2021 in MI
Enrollment address
12250 E 12 Mile Rd
Warren, MI 48093-3516
Nursing home name
THE ORCHARDS AT WARREN
Affiliated entity
THE ORCHARDS MICHIGAN

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Orchards at WarrenCCN 235509
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Sep 30, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
134122.5 residents per day on average
Chain
The Orchards Michigan15 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Myrna Lee Individual W-2 Managing EmployeeAdministrator Jun 1, 2022
Isaac Gutman Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2022 30%
Jacob Taub Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2022 30%
Warren SNF Holdco LLC Organization, Lakewood, NJ LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Jun 1, 2022 100%
Alexander Hoffman Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2022 30%
Judith Beaupre Individual W-2 Managing EmployeeDirector of Nursing Jun 1, 2022
Mi Opco Holdco LLC Organization, Lakewood, NJ LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 1, 2022 100%
Robert Kornfeld Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2022 10%
Corporate OfficerChief Executive Officer Jun 1, 2022

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 3

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": "1633046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1558033175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "362 E KENNEDY BLVD",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087011434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12250 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933516",
            "telephone_number": "718-838-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WARREN MI OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-01",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "KORN",
        "authorized_official_first_name": "ROB",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "718-838-1501"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

Verify at the official NPI Registry.