NPIMap

Organization Active NPI

Florida Department of Veterans Affairs

  • Skilled Nursing Facility
  • Port St Lucie, FL
National Provider Identifier
1639811342
Registry record updated Jul 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
FLORIDA DEPARTMENT OF VETERANS AFFAIRS
Practice address
13000 SW Tradition Pkwy
Port St Lucie, FL 34987-2885
Phone
(772) 241-6132
NPI assigned
Apr 12, 2022
Organization subpart
Yes
Parent organization
FLORIDA DEPARTMENT OF VETERANS' AFFAIRSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 8, 2026

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

Authorized official

Name
Connie Sue Tolley
Title
Director Fdva Homes
Phone
(727) 518-3203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

13000 SW Tradition Pkwy
Port St Lucie, FL 34987-2885

Mailing address

13000 SW Tradition Pkwy
Port St Lucie, FL 34987-2885
Phone (772) 241-6132

Other names 1

  • Ardie R. Copas State Veterans Nursing Home Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220809003884 FL Part A Provider - Skilled Nursing Facility 5698686608 Practice locations: Port St Lucie, FL

Skilled nursing facility certification: CCN 686128

Legal name
FLORIDA DEPARTMENT OF VETERANS AFFAIRS
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 6, 2022
Last certification
Mar 14, 2024
Beds
120
Ownership / control type
State
Multi-facility organization
Forida Department of Veteran Affairs
Organization structure
GovernmentProprietary
Enrollment address
13000 SE Tradition Pkwy
Port St Lucie, FL 34987-2885
Nursing home name
ARDIE R COPAS STATE VETERANS NURSING HOME
Affiliated entity
FLORIDA DEPARTMENT OF VETERANS' AFFAIRS

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Ardie R Copas State Veterans Nursing HomeCCN 686128
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Government - State
Certified
Dec 6, 2022
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120114.8 residents per day on average
Chain
Florida Department of Veterans' Affairs7 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Florida Department of Veterans Affairs12 organizations share this tax ID, including this one
Part of
Florida Department of Veterans Affairs

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

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.

NameRoleSinceShare
Ahmad Fadel Individual Operational/Managerial Control Jun 30, 2023
Adp of the SNF Apr 2, 2025
Florida Department of Veterans Affairs Organization, Largo, FL 5% Or Greater Direct Ownership Interest Jun 30, 2022 100%
Vicki Dickerson Individual Operational/Managerial Control Jun 30, 2023
Donna Rogers Individual Corporate DirectorAdministrator Oct 1, 2021
Adp of the SNF Apr 2, 2025
Lindsay Mallard Individual Operational/Managerial Control Oct 16, 2016

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Emory L. Bennett State Veterans' Nursing HomeDaytona Beach, FL, CCN 105840 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 18, 2014
Clyde E Lassen State Veterans Nursing HomeSt Augustine, FL, CCN 106088 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2010
Douglas Jacobson State Veterans' Nursing HomePort Charlotte, FL, CCN 106059 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2004
Clifford Chester Sims State Veterans' Nursing HomePanama City, FL, CCN 106056 Skilled nursing facility Direct Ownership Interest (100%) Aug 1, 2003
Baldermo Lopez State Veterans' Nursing HomeLand O Lakes, FL, CCN 106006 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1999
Florida Department of Veterans AffairsOrlando, FL, CCN 106151 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2023

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

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": "1649721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783468800000",
    "number": "1639811342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13000 SW TRADITION PKWY",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349872885",
            "telephone_number": "772-241-6132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13000 SW TRADITION PKWY",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349872885",
            "telephone_number": "772-241-6132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA DEPARTMENT OF VETERANS AFFAIRS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FLORIDA DEPARTMENT OF VETERANS' AFFAIRS",
        "enumeration_date": "2022-04-12",
        "last_updated": "2026-07-08",
        "certification_date": "2026-07-08",
        "status": "A",
        "authorized_official_last_name": "TOLLEY",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "DIRECTOR FDVA HOMES",
        "authorized_official_telephone_number": "727-518-3203"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ardie R. Copas State Veterans Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ardie R. Copas State Veterans Nursing Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

Verify at the official NPI Registry.