Village Care of King, LLC
Organization Active NPI Skilled Nursing Facility · King, NC
NPI 1629515499 · NPPES record last updated Dec 19, 2022
Key facts
- NPI
- 1629515499
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- VILLAGE CARE OF KING, LLC
- Practice address
- 440 Ingram Dr
King, NC 27021-8208 - Phone
- (336) 983-4900
- Fax
- (336) 983-4710
- NPI assigned
- Jan 31, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- SABER HEALTHCARE HOLDINGS, LLC
Authorized official
- Name
- William I Weisberg
- Title
- President
- Phone
- (216) 292-5706
Owners & managing parties with NPI records 19
Corporate family (same tax ID) 1
Member of 1
Facilities with the same owner 116
Affiliated clinicians 1
Medicare Care Compare: Nursing home
- Listed as
- Village Care of King
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jul 11, 1991
- Medicare certification status
- Active
- Certified beds
- 96 · 88.8 residents per day on average
- Chain
- Saber Healthcare Group
- Penalties (3 years)
- 3 · fines totaling $110,113
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Skilled nursing facility certification: CCN 345381
- Legal name
- VILLAGE CARE OF KING LLC
- Doing business as
- VILLAGE CARE OF KING
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 11, 1991
- Last certification
- Oct 10, 2024
- Beds
- 96
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Saber Healthcare
- Organization structure
- LLC · Proprietary
- Incorporated
- Jan 11, 2017 in NC
- Enrollment address
- 440 Ingram Dr
King, NC 27021-8208 - Nursing home name
- VILLAGE CARE OF KING
- Affiliated entity
- SABER HEALTHCARE GROUP
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Saber Healthcare Holdings LLC |
5% Or Greater Indirect Ownership Interest | Apr 1, 2017 | 100% |
| WWBV Holdings LLC |
5% Or Greater Indirect Ownership Interest | Sep 30, 2019 | 100% |
| Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020) |
5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 33% |
| Amy Musick |
W-2 Managing Employee |
Oct 25, 2021 | 100% |
| Gregory Nicoluzakis |
Corporate Officer |
Mar 1, 2019 | |
| SHG Management LLC |
Other | Sep 1, 2019 | |
| Saber Governance LLC |
Operational/Managerial Control | Sep 1, 2019 | 100% |
| BNV Dynasty LLC |
5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 33% |
| Benjamin N Volpe |
Corporate Officer |
Mar 1, 2019 | |
| Corporate Director |
Mar 1, 2019 | 50% | |
| SHG Autumn, LLC |
5% Or Greater Indirect Ownership Interest | Apr 1, 2017 | 100% |
| Wiw Dynasty LLC |
5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 67% |
| William I Weisberg |
Corporate Officer |
Mar 1, 2019 | |
| Corporate Director |
Mar 1, 2019 | 50% | |
| Autumn Corporation |
5% Or Greater Direct Ownership Interest | Apr 1, 2017 | 100% |
| SHH Holdings LLC |
5% Or Greater Indirect Ownership Interest | Mar 1, 2019 | 100% |
| Decanted William I. Weisberg Family Dynasty Trust (Dated Sept 30, 2020 |
5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 67% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170329002681 | NC | Part a Provider - Skilled Nursing Facility | 1658656863 | Practice locations: King, NC |
National Provider Directory
- Tax ID family
- Autumn Corporation
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Care Home Facility | 311ZA0620X | |||
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
440 Ingram Dr
King, NC 27021-8208
Mailing address
23700 Commerce Park
Beachwood, OH 44122-5827
Phone (216) 292-5706
Other names
- Village Care of King
Other providers in King, NC
- Linda A. Turner
- Taylor Grace Turner
- Twin City Anesthesia PLLC
- Universal Health Care / King, Inc
- Calvin Douglas Vandergrift
- Visionaires Solutions Inc.
- Lori McCombs Wade
- Sharon Darlene Wagner
- Wake Forest University Baptist Medical Center Community Physicians
- Wake Forest University Baptist Medical Center Community Physicians
All providers in King, NC · Skilled Nursing Facility in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.