Organization Active NPI

Shelton Lakes Health Care Center, Inc

  • Skilled Nursing Facility
  • Shelton, CT
National Provider Identifier
1669502365
Registry record updated Oct 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2298-C Issued in CT
Legal business name
SHELTON LAKES HEALTH CARE CENTER, INC
Practice address
5 Lake Rd
Shelton, CT 06484-2967
Phone
(203) 924-2635
Fax
(203) 924-0034
NPI assigned
Mar 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2014

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

Authorized official

Name
Mr. Mark Hambley
Title
Cfo
Phone
(860) 678-9755

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2298-C CT Primary

Addresses

Primary practice location

5 Lake Rd
Shelton, CT 06484-2967

Mailing address

5 Lake Rd
Shelton, CT 06484-2967
Phone (203) 924-2635

Other identifiers 1

IdentifierTypeStateIssuer
000010173MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041221000200 CT Part A Provider - Skilled Nursing Facility 3779541941 Practice locations: Shelton, CT

Skilled nursing facility certification: CCN 075300

Legal name
SHELTON LAKES HEALTH CARE CENTER INC
Doing business as
APPLE REHAB SHELTON LAKES
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 17, 1982
Last certification
Dec 9, 2024
Beds
106
Ownership / control type
Corporation
Multi-facility organization
APPLE REHAB
Most recent change of ownership
Nov 1, 2004
Organization structure
CorporationProprietary
Incorporated
Nov 1, 2004 in CT
Enrollment address
5 Lake Rd
Shelton, CT 06484-2967
Nursing home name
APPLE REHAB SHELTON LAKES
Affiliated entity
APPLE REHAB

Care Compare: Nursing home

Medicare Care Compare
Listed as
Apple Rehab Shelton LakesCCN 075300
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Nov 17, 1982
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
106100.0 residents per day on average
Chain
Apple Rehab20 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D0097696Apple Rehab Shelton Lakes5 Lake Road, Shelton, CT 06484Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Apple Rehab Shelton Lakes2 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.

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Devika Singh Individual W-2 Managing Employee Sep 10, 2018
Ryan a Vess Individual Corporate OfficerCfo Mar 15, 2013
Corporate DirectorCfo Mar 15, 2013
Operational/Managerial ControlCfo Mar 15, 2013
Brian J. Foley Individual 5% Or Greater Direct Ownership Interest Nov 1, 2004 100%
5% Or Greater Mortgage Interest Nov 1, 2004 100%
Corporate OfficerPresident Nov 4, 2004 100%

Practitioners & affiliated clinicians

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": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413417600000",
    "number": "1669502365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 LAKE RD",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064842967",
            "telephone_number": "203-924-2635",
            "fax_number": "203-924-0034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 LAKE RD",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064842967",
            "telephone_number": "203-924-2635",
            "fax_number": "203-924-0034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELTON LAKES HEALTH CARE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2014-10-16",
        "status": "A",
        "authorized_official_last_name": "HAMBLEY",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "860-678-9755",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "2298-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000010173",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, CT

Sources for this page

Verify at the official NPI Registry.