Active NPI
Willow Ridge Healthcare LLC
- Skilled Nursing Facility
- Rutherfordton, NC
National Provider Identifier
1629425491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- WILLOW RIDGE HEALTHCARE LLC
- Practice address
- 237 Tryon Rd
Rutherfordton, NC 28139-3058 - Phone
- (828) 286-7200
- Fax
- (828) 287-3668
- NPI assigned
- May 20, 2016
- 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
- Mr. Jacob S. Stern
- Title
- Manager
- Phone
- (732) 659-1353
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
237 Tryon Rd
Rutherfordton, NC 28139-3058
Mailing address
100 Route 70 Ste 3
Lakewood, NJ 08701-7406
Phone (732) 659-1353
Other names 1
- Willow Ridge of NC
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160826000111 | NC | Part A Provider - Skilled Nursing Facility | 0143515379 | Practice locations: Rutherfordton, NC |
Skilled nursing facility certification: CCN 345197
- Legal name
- WILLOW RIDGE HEALTHCARE LLC
- Doing business as
- WILLOW RIDGE OF NC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 6, 1980
- Last certification
- Feb 4, 2025
- Beds
- 150
- Ownership / control type
- Corporation
- Multi-facility organization
- CCH Healthcare
- Organization structure
- LLC
- Incorporated
- Feb 24, 2016 in DE
- Enrollment address
- 237 Tryon Road
Rutherfordton, NC 28139 - Nursing home name
- WILLOW RIDGE OF NC
- Affiliated entity
- CCH HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Willow Ridge Of NC
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Mar 6, 1980
- Medicare certification status
- Active
- Certified beds
- 150
- Chain
- CCH Healthcare
- Penalties (3 years)
- 5
National Provider Directory
National Provider Directory- Tax ID family
- Willow Ridge Healthcare LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Skilled Nursing Facility
- Rutherfordton, NC
- NPI 1609886159
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 |
|---|---|---|---|
| CCH Healthcare LLC | 5% Or Greater Indirect Ownership Interest | Jun 1, 2016 | 100% |
| Thomas Neshek | Other | Jun 1, 2016 | |
| Adam R Bealer | Operational/Managerial Control | Jan 15, 2015 | 100% |
| Forbright Bank | 5% Or Greater Security Interest | Jun 1, 2016 | |
| Jacob Stern | 5% Or Greater Direct Ownership Interest | Jun 1, 2016 | 100% |
| 5% Or Greater Indirect Ownership Interest | Jun 1, 2016 | 100% | |
| Operational/Managerial Control | Jun 1, 2016 | 100% | |
| Other | Jun 1, 2016 | 100% |
Facilities with the same owner 2
Facilities that share an organizational owner with 5% or greater ownership or operational control.
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Hendersonville, NC
- NPI 1619950557
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": "1463702400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1463702400000",
"number": "1629425491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 ROUTE 70 STE 3",
"city": "LAKEWOOD",
"state": "NJ",
"postal_code": "087017406",
"telephone_number": "732-659-1353",
"fax_number": "866-306-0259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "237 TRYON RD",
"city": "RUTHERFORDTON",
"state": "NC",
"postal_code": "281393058",
"telephone_number": "828-286-7200",
"fax_number": "828-287-3668"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WILLOW RIDGE HEALTHCARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2016-05-20",
"last_updated": "2016-05-20",
"status": "A",
"authorized_official_last_name": "STERN",
"authorized_official_first_name": "JACOB",
"authorized_official_middle_name": "S.",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "732-659-1353",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Willow Ridge of NC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Rutherfordton, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2016; 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.