Agawam South Rehab and Nursing LLC
Organization Active NPI Skilled Nursing Facility · Agawam, MA
NPI 1639856461 · NPPES record last updated Aug 15, 2023
Key facts
- NPI
- 1639856461
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 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
- Organization subpart
- No
Authorized official
- Name
- Benjamin Friedman
- Title
- Cfo
- Phone
- (845) 414-3300
Owners & managing parties with NPI records 2
Facilities with the same owner 22
Practitioners 1
Affiliated clinicians 1
Medicare Care Compare: Nursing home
- Listed as
- Agawam South Rehab and Nursing
- 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
- Active
- Certified beds
- 122 · 95.8 residents per day on average
- Chain
- Stern Consultants
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 22D0066395 | Agawam South Rehab and Nursing LLC | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
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
- LLC · Proprietary
- 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
All disclosed owners & managing parties 29
| Name | Role | Since | Share |
|---|---|---|---|
| Tlco Holdings LLC |
5% Or Greater Direct Ownership Interest | Oct 16, 2023 | 21% |
| Operational/Managerial Control | Oct 16, 2023 | ||
| Adp of the SNF | Oct 16, 2023 | ||
| |
Indirect Ownership Interest | Oct 16, 2023 | 0.33% |
| Boruch Sheps |
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 |
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 | ||
| |
Adp of the SNF | Jul 13, 2025 | |
| Chaim Millman |
Corporate Officer |
Oct 16, 2023 | 100% |
| 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% | |
| |
Adp of the SNF | Oct 16, 2023 | |
| Direct Ownership Interest | Oct 16, 2023 | 1% | |
| Benjamin Friedman |
Operational/Managerial Control | Oct 16, 2023 | |
| Adp of the SNF | Oct 16, 2023 | ||
| Direct Ownership Interest | Oct 16, 2023 | 3.5% | |
| Brittany Beatty |
Operational/Managerial Control | Oct 16, 2023 | |
| Adp of the SNF | Oct 16, 2023 | ||
| Direct Ownership Interest | Oct 16, 2023 | 2% | |
| Etn Family Holdings LLC |
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 |
5% Or Greater Direct Ownership Interest | Oct 16, 2023 | 9% |
| Adp of the SNF | Oct 16, 2023 | ||
| T Newhouse Family Trust |
5% Or Greater Indirect Ownership Interest | Oct 16, 2023 | 10.4% |
| Adp of the SNF | Oct 16, 2023 | ||
| Marta Subira |
Operational/Managerial Control | Apr 22, 2024 | |
| Adp of the SNF | Oct 16, 2023 | ||
| |
Direct Ownership Interest | Oct 16, 2023 | 2% |
| Agawam South Propco LLC |
Adp of the SNF | Oct 16, 2023 | |
| |
Trustee of the SNF | Oct 16, 2023 | |
| Eric Newhouse |
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 |
5% Or Greater Direct Ownership Interest | Oct 16, 2023 | 11.5% |
| Com Family Trust |
5% Or Greater Indirect Ownership Interest | Oct 16, 2023 | 10.4% |
| Adp of the SNF | Oct 16, 2023 | ||
| |
Adp of the SNF | Jul 13, 2025 | |
| Andrea Plew |
Operational/Managerial Control | Oct 16, 2023 | |
| Adp of the SNF | Oct 16, 2023 | ||
| Rami a Ashkar |
Operational/Managerial Control | Oct 16, 2023 | |
| Adp of the SNF | Oct 16, 2023 | ||
| Stern Therapy Consultants LLC |
Operational/Managerial Control | Oct 16, 2023 | |
| Adp of the SNF | Jul 13, 2025 | ||
| |
Adp of the SNF | Jul 13, 2025 | |
| |
Trustee of the SNF | Oct 16, 2023 | |
| TLM Family Trust |
5% Or Greater Indirect Ownership Interest | Oct 16, 2023 | 10.4% |
| Adp of the SNF | Oct 16, 2023 | ||
| |
Indirect Ownership Interest | Oct 16, 2023 | 1.33% |
| |
Adp of the SNF | Oct 16, 2023 | |
| Direct Ownership Interest | Oct 16, 2023 | 1% | |
| E Newhouse Family Trust |
5% Or Greater Indirect Ownership Interest | Oct 16, 2023 | 10.4% |
| Adp of the SNF | Oct 16, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231024003832 | MA | Part a Provider - Skilled Nursing Facility | 6901252113 | Practice locations: Agawam, MA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
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
Other providers in Agawam, MA
- Paulo Afonso
- Agawam East Rehab and Nursing LLC
- Agawam Medical Supply Corp
- Agawam North Rehab and Nursing LLC
- Agawam Nursing LLC
- Agawam West Rehab and Nursing LLC
- Danielle Leigh Allard
- Am Medical PC
- Heidi Lee Amaral
- Amedisys Hospice LLC
All providers in Agawam, MA · Skilled Nursing Facility in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2023. 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.