Active NPI
1539 Country Club Road Operations LLC
Doing business as Tygart Center at Fairmount Campus
- Skilled Nursing Facility
- Fairmont, WV
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 62
- Legal business name
- 1539 COUNTRY CLUB ROAD OPERATIONS LLC
- Doing business as
- Tygart Center at Fairmount Campus
- Practice address
- 1539 Country Club Rd
Fairmont, WV 26554-1306 - Phone
- (304) 366-9100
- NPI assigned
- Dec 30, 2008
- Last updated
- Jun 23, 2025
- 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
- Michael Berg
- Title
- Secretary
- Phone
- (610) 444-6350
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 62 | WV | Primary |
Addresses
Primary practice location
1539 Country Club Rd
Fairmont, WV 26554-1306
Mailing address
101 E State St
Kennett Square, PA 19348-3109
Phone (610) 925-4436
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810013992 | Medicaid | WV |
Other names 1
- Tygart Center at Fairmount Campus
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090206000597 | WV | Part A Provider - Skilled Nursing Facility | 5395800320 | Practice locations: Fairmont, WV |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1578709341. Details of each certification follow.
Skilled nursing facility certification: CCN 515053
- Legal name
- 1539 COUNTRY CLUB ROAD OPERATIONS LLC
- Doing business as
- TYGART CENTER AT FAIRMONT CAMPUS
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Feb 13, 1975
- Last certification
- May 6, 2025
- Beds
- 119
- Ownership / control type
- Corporation
- Multi-facility organization
- Genesis Healthcare
- Organization structure
- LLC
- Incorporated
- Nov 14, 2007 in WV
- Enrollment address
- 1539 Country Club Road
Fairmont, WV 26554-1306 - Nursing home name
- TYGART CENTER AT FAIRMONT CAMPUS
- Affiliated entity
- GENESIS HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Tygart Center at Fairmont Campus
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Feb 13, 1975
- Medicare certification status
- Active
- Certified beds
- 119
- Chain
- Genesis Healthcare
- Penalties (3 years)
- 1
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 23
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 |
|---|---|---|---|
| Genesis Omg Operations LLC | 5% Or Greater Indirect Ownership Interest | Dec 1, 2012 | 100% |
| Laura Bridgeford | Corporate Officer | Jun 1, 2024 | |
| Adp of the SNF | Mar 24, 2025 | ||
| Adp of the SNF | Mar 24, 2025 | ||
| HCCF Management Group XI LLC | 5% Or Greater Indirect Ownership Interest | Nov 15, 2022 | 10.8% |
| Gen Operations I LLC | 5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| Gen Operations II LLC | 5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| Diane Louise Morris | Operational/Managerial Control | Dec 23, 2023 | |
| Adp of the SNF | Dec 27, 2023 | ||
| FC-Gen Operations Investment LLC | 5% Or Greater Indirect Ownership Interest | Jan 1, 2012 | 100% |
| Sundance Rehabilitation Holdco Inc | 5% Or Greater Indirect Ownership Interest | Mar 2, 2015 | 5.2% |
| Genesis Healthcare LLC | 5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| Sun Healthcare Group Inc | 5% Or Greater Indirect Ownership Interest | Nov 15, 2022 | 65.3% |
| Sara Holler | Operational/Managerial Control | Jun 1, 2024 | |
| Adp of the SNF | Jun 1, 2024 | ||
| Welltower Op, LLC | 5% Or Greater Indirect Ownership Interest | Mar 1, 2024 | 5.7% |
| Arnold M Whitman | 5% Or Greater Indirect Ownership Interest | Nov 15, 2022 | 10.8% |
| Genesis Healthcare Inc | 5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| Zac Properties XI LLC | 5% Or Greater Indirect Ownership Interest | Nov 15, 2022 | 7.6% |
| Steven E Fishman | 5% Or Greater Indirect Ownership Interest | Nov 15, 2022 | 7.6% |
| Avi Pinchas Mendelson | Corporate Officer | Jun 1, 2024 | |
| Michael T Berg | Corporate Officer | Mar 2, 2015 | |
| Adp of the SNF | Mar 24, 2025 | ||
| GHC Holdings LLC | 5% Or Greater Indirect Ownership Interest | Jan 1, 2012 | 100% |
| Genesis Holdings LLC | 5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
Facilities with the same owner 176
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Marmet Center
- Skilled Nursing Facility
- Marmet, WV
- NPI 1538343710
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation
-
dba Valley Center
- Skilled Nursing Facility
- South Charleston, WV
- NPI 1558545749
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation
-
dba Heritage Center
- Skilled Nursing Facility
- Huntington, WV
- NPI 1912181223
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation
-
dba Ansted Center
- Skilled Nursing Facility
- Ansted, WV
- NPI 1639353816
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation
-
dba Pierpont Center at Fairmont Campus
- Skilled Nursing Facility
- Fairmont, WV
- NPI 1396981064
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, Genesis Omg Operations LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group
-
dba Madison Center
- Skilled Nursing Facility
- Morgantown, WV
- NPI 1073797387
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation
-
dba Raleigh Center
- Skilled Nursing Facility
- Daniels, WV
- NPI 1063696243
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation
-
dba Ravenswood Village
- Skilled Nursing Facility
- Ravenswood, WV
- NPI 1124202304
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation
-
dba Sistersville Center
- Skilled Nursing Facility
- Sistersville, WV
- NPI 1831373026
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation
-
dba Care Haven Center
- Skilled Nursing Facility
- Martinsburg, WV
- NPI 1053595355
Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Z
-
dba Cedar Ridge Center
- Skilled Nursing Facility
- Sissonville, WV
- NPI 1689858987
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation
-
dba Pine View Center
- Skilled Nursing Facility
- Harrisville, WV
- NPI 1982484671
FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, GHC Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Internal Medicine Physician
- Morgantown, WV
- NPI 1376515692
-
- Internal Medicine Physician
- Morgantown, WV
- NPI 1568099513
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": "1230595200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1750636800000",
"number": "1578709341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 E STATE ST",
"city": "KENNETT SQUARE",
"state": "PA",
"postal_code": "193483109",
"telephone_number": "610-925-4436",
"fax_number": "610-612-5327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1539 COUNTRY CLUB RD",
"city": "FAIRMONT",
"state": "WV",
"postal_code": "265541306",
"telephone_number": "304-366-9100"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "1539 COUNTRY CLUB ROAD OPERATIONS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-12-30",
"last_updated": "2025-06-23",
"certification_date": "2025-06-23",
"status": "A",
"authorized_official_last_name": "BERG",
"authorized_official_first_name": "MICHAEL",
"authorized_official_title_or_position": "SECRETARY",
"authorized_official_telephone_number": "610-444-6350"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "WV",
"license": "62",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810013992",
"state": "WV"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Tygart Center at Fairmount Campus",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fairmont, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2025; 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.