3G Operating Company LLC
Organization Active NPI Skilled Nursing Facility · Wickliffe, OH
NPI 1699773283 · NPPES record last updated Sep 27, 2022
Key facts
- NPI
- 1699773283
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 2772 (OH)
- Legal business name
- 3G OPERATING COMPANY LLC
- Practice address
- 1919 Bishop Rd
Wickliffe, OH 44092-2518 - Phone
- (440) 944-9400
- Fax
- (330) 944-2491
- NPI assigned
- Jul 8, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Barry Stump
- Title
- Cfo
- Phone
- (216) 898-8399
Corporate family (same tax ID) 1
Facilities with the same owner 10
Practitioners 4
-
Harigopal Balaji, MD
-
Dharmesh Mehta, M.D.
-
Beejadi N Mukunda, M.D.
-
Marinela L Turc, M.D.
Affiliated clinicians 2
-
Harigopal Balaji, MD
-
Dharmesh Mehta, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Wickliffe Country Place
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jul 13, 1978
- Medicare certification status
- Active
- Certified beds
- 170 · 124.3 residents per day on average
- Chain
- Legacy Health Services
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D0334890 | Wickliffe Country Place | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Skilled nursing facility certification: CCN 365381
- Legal name
- 3G OPERATING COMPANY LLC
- Doing business as
- WICKLIFFE COUNTRY PLACE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 13, 1978
- Last certification
- Sep 26, 2024
- Beds
- 170
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- OH 10 Holdco, LLC
- Organization structure
- LLC · Proprietary
- Incorporated
- Jun 22, 2007 in OH
- Enrollment address
- 1919 Bishop Rd
Wickliffe, OH 44092-2518 - Nursing home name
- WICKLIFFE COUNTRY PLACE
- Affiliated entity
- LEGACY HEALTH SERVICES
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Lionsview Opco NR LLC |
5% Or Greater Indirect Ownership Interest | Jul 6, 2022 | 15.6% |
| Chavos221 Holdings LLC |
5% Or Greater Indirect Ownership Interest | Jul 6, 2022 | 40% |
| Barry Stump |
Corporate Officer |
Jun 22, 2007 | |
| W-2 Managing Employee |
Jun 22, 2007 | ||
| CC Oh10 Opco LLC |
5% Or Greater Indirect Ownership Interest | Jul 6, 2022 | 39.4% |
| Sapphire143 Holdings LLC |
5% Or Greater Indirect Ownership Interest | Jul 6, 2022 | 19.5% |
| Living26 Irrv TR |
5% Or Greater Indirect Ownership Interest | Jul 6, 2022 | 18% |
| Eliav Sharvit |
Corporate Officer |
Jun 22, 2007 | |
| Oh 10 Holdco LLC |
5% Or Greater Direct Ownership Interest | Jul 6, 2022 | 100% |
| Sapphire143 Irrv TR |
5% Or Greater Indirect Ownership Interest | Jul 6, 2022 | 18% |
| Living26 Holdings LLC |
5% Or Greater Indirect Ownership Interest | Jul 6, 2022 | 19.5% |
| Lionsview SC LLC |
5% Or Greater Indirect Ownership Interest | Jul 6, 2022 | 5% |
| Chavos221 Irrv TR |
5% Or Greater Indirect Ownership Interest | Jul 6, 2022 | 38% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080207000096 | OH | Part a Provider - Skilled Nursing Facility | 9436247582 | Practice locations: Wickliffe, OH |
National Provider Directory
- Tax ID family
- 3G Operating Company LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 2772 | OH | Yes |
Addresses
Primary practice location
1919 Bishop Rd
Wickliffe, OH 44092-2518
Mailing address
1919 Bishop Rd
Wickliffe, OH 44092-2518
Phone (440) 944-9400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2777062 | Medicaid | OH |
Other names
- Wickliffe Country Place
Other providers in Wickliffe, OH
- 3 G Operating Company, LLC
- A Commitment to Love You Inc.
- Afbdc Willoughby Hills Family Chiropractic
- Robert Allen
- Almazmedicaltransportation
- Kristen E Angelo
All providers in Wickliffe, OH · Skilled Nursing Facility in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2022. 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.