NPIMap

Organization Active NPI

Agawam South Rehab and Nursing LLC

  • Skilled Nursing Facility
  • Agawam, MA
National Provider Identifier
1639856461
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
AGAWAM SOUTH REHAB AND NURSING LLC
Practice address
65 Cooper St
Agawam, MA 01001-2149
Phone
(413) 786-8000
Fax
(413) 306-6401
NPI assigned
Jul 3, 2023
Last updated
Aug 15, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Authorized official

Name
Benjamin Friedman
Title
Cfo
Phone
(845) 414-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

65 Cooper St
Agawam, MA 01001-2149

Mailing address

7B Medical Park Dr
Pomona, NY 10970-3516
Phone (845) 414-3300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231024003832 MA Part A Provider - Skilled Nursing Facility 6901252113 Practice locations: Agawam, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639856461. Details of each certification follow.

Skilled nursing facility certification: CCN 225176

Legal name
AGAWAM SOUTH REHAB AND NURSING LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 4, 1969
Last certification
Nov 26, 2024
Beds
122
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
May 26, 2023 in MA
Enrollment address
65 Cooper St
Agawam, MA 01001-2149
Nursing home name
AGAWAM SOUTH REHAB AND NURSING
Affiliated entity
STERN CONSULTANTS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Agawam South Rehab and NursingCCN 225176 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 4, 1969
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12295.8 residents per day on average
Chain
Stern Consultants22 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 29

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

NameRoleSinceShare
Tlco Holdings LLC Organization, Pomona, NY LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 16, 2023 21%
Operational/Managerial Control Oct 16, 2023
Adp of the SNF Oct 16, 2023
Individual Indirect Ownership Interest Oct 16, 2023 0.33%
Boruch Sheps Individual 5% Or Greater Direct Ownership Interest Oct 16, 2023 14.5%
Operational/Managerial Control Oct 16, 2023
Managing Control - Governing Body Oct 16, 2023
Adp of the SNF Oct 16, 2023
Avraham Erblich Individual 5% Or Greater Direct Ownership Interest Oct 16, 2023 13.5%
Operational/Managerial Control Oct 16, 2023 100%
Managing Control - Governing Body Oct 16, 2023
Adp of the SNF Oct 16, 2023
Organization, Simsbury, CT LLC, Consulting firm Adp of the SNF Jul 13, 2025
Chaim Millman Individual Corporate OfficerManaging Member Oct 16, 2023 100%
Operational/Managerial Control Oct 16, 2023
Managing Control - Governing BodyManaging Member Oct 16, 2023
Trustee of the SNF Oct 16, 2023
Adp of the SNF Oct 16, 2023
Indirect Ownership Interest Oct 16, 2023 0.01%
Individual Adp of the SNF Oct 16, 2023
Direct Ownership Interest Oct 16, 2023 1%
Benjamin Friedman Individual Operational/Managerial Control Oct 16, 2023
Adp of the SNF Oct 16, 2023
Direct Ownership Interest Oct 16, 2023 3.5%
Brittany Beatty Individual Operational/Managerial Control Oct 16, 2023
Adp of the SNF Oct 16, 2023
Direct Ownership Interest Oct 16, 2023 2%
Etn Family Holdings LLC Organization, Suffern, NY LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 16, 2023 21%
Operational/Managerial Control Oct 16, 2023
Adp of the SNF Jul 13, 2025
Bezalel Stern Individual 5% Or Greater Direct Ownership Interest Oct 16, 2023 9%
Adp of the SNF Oct 16, 2023
T Newhouse Family Trust Organization, Suffern, NY 5% Or Greater Indirect Ownership Interest Oct 16, 2023 10.4%
Adp of the SNF Oct 16, 2023
Marta Subira Individual Operational/Managerial Control Apr 22, 2024
Adp of the SNF Oct 16, 2023
Organization, Clifton, NJ LLC, Owned by another organization or individual Direct Ownership Interest Oct 16, 2023 2%
Agawam South Propco LLC Organization, Pomona, NY LLC Adp of the SNF Oct 16, 2023
Individual Trustee of the SNF Oct 16, 2023
Eric Newhouse Individual Operational/Managerial Control Oct 16, 2023
Managing Control - Governing Body Oct 16, 2023
Trustee of the SNF Oct 16, 2023
Adp of the SNF Oct 16, 2023
Indirect Ownership Interest Oct 16, 2023 0.01%
Shana Friedman Individual 5% Or Greater Direct Ownership Interest Oct 16, 2023 11.5%
Com Family Trust Organization, Pomona, NY 5% Or Greater Indirect Ownership Interest Oct 16, 2023 10.4%
Adp of the SNF Oct 16, 2023
Organization, Cedarhurst, NY Corporation, Consulting firm Adp of the SNF Jul 13, 2025
Andrea Plew Individual Operational/Managerial Control Oct 16, 2023
Adp of the SNF Oct 16, 2023
Rami a Ashkar Individual Operational/Managerial Control Oct 16, 2023
Adp of the SNF Oct 16, 2023
Stern Therapy Consultants LLC Organization, Pomona, NY LLC Operational/Managerial Control Oct 16, 2023
Adp of the SNF Jul 13, 2025
Organization, Pomona, NY LLC Adp of the SNF Jul 13, 2025
Individual Trustee of the SNF Oct 16, 2023
TLM Family Trust Organization, Pomona, NY 5% Or Greater Indirect Ownership Interest Oct 16, 2023 10.4%
Adp of the SNF Oct 16, 2023
Individual Indirect Ownership Interest Oct 16, 2023 1.33%
Individual Adp of the SNF Oct 16, 2023
Direct Ownership Interest Oct 16, 2023 1%
E Newhouse Family Trust Organization, Suffern, NY 5% Or Greater Indirect Ownership Interest Oct 16, 2023 10.4%
Adp of the SNF Oct 16, 2023

Owners & managing parties with NPI records 2

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

Facilities with the same owner 22

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

View all 22

Practitioners & affiliated clinicians

Practitioners 1

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.

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": "1688342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692057600000",
    "number": "1639856461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7B MEDICAL PARK DR",
            "city": "POMONA",
            "state": "NY",
            "postal_code": "109703516",
            "telephone_number": "845-414-3300",
            "fax_number": "845-517-4796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 COOPER ST",
            "city": "AGAWAM",
            "state": "MA",
            "postal_code": "010012149",
            "telephone_number": "413-786-8000",
            "fax_number": "413-306-6401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAWAM SOUTH REHAB AND NURSING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-03",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A",
        "authorized_official_last_name": "FRIEDMAN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "845-414-3300"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Agawam, MA

Sources for this page

Verify at the official NPI Registry.