Bristol SNF Operations, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

BRISTOL SNF OPERATIONS, LLC

Practice address

23 Fair St
Bristol, CT 06010-5531

Phone

(860) 589-2923

NPI assigned

Jan 16, 2025

Last updated

Jan 16, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Phil Bak

Title

Managing Partner

Phone

(908) 783-3110

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669283883. Details of each certification follow.

• CCN 075198001 Skilled nursing facility · Details

Skilled nursing facility certification: CCN 075198001

Legal name

BRISTOL SNF OPERATIONS, LLC

Doing business as

VILLAGE GREEN REHABILITATION AND HEALTHCARE CENTER

Organization structure

LLCProprietary

Enrollment address

23 Fair St
Bristol, CT 06010-5531

Nursing home name

VILLAGE GREEN REHABILITATION AND HEALTHCARE CENTER

Affiliated entity

ATLAS HEALTHCARE

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Bristol SNF Operations LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Bristol SNF Operations, LLC

  • Nursing Facility/Intermediate Care Facility
  • Bristol, CT
  • NPI 1861204307
  NPD tax ID

All disclosed owners & managing parties 21

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

Owners & managing parties with NPI records 1

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

• Benjamin Yeboah, MD

  • Internal Medicine Physician
  • New Haven, CT
  • NPI 1174705636

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Bristol SNF Operations, LLC

  • Nursing Facility/Intermediate Care Facility
  • Bristol, CT
  • NPI 1861204307
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736985600000",
    "number": "1669283883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BOULEVARD OF AMERICAS",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087014585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 FAIR ST",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060105531",
            "telephone_number": "860-589-2923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRISTOL SNF OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-16",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A",
        "authorized_official_last_name": "BAK",
        "authorized_official_first_name": "PHIL",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "908-783-3110"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Bristol, CT
• Providers in Bristol, CT by specialty
• Skilled Nursing Facility in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; 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.

Verify at the official NPI Registry.