NPIMap

Organization Active NPI

Healthpark Care Center, Inc.

Doing business as HealthPark Care Center

  • Skilled Nursing Facility
  • Fort Myers, FL
National Provider Identifier
1699786061
Registry record updated Aug 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
SNF1202096 Issued in FL
Legal business name
HEALTHPARK CARE CENTER, INC.
Doing business as
HealthPark Care Center
Practice address
16131 Roserush CT
Fort Myers, FL 33908-3634
Phone
(239) 433-4647
Fax
(239) 432-3456
NPI assigned
Aug 11, 2006
Last updated
Aug 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2015

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

Authorized official

Name
Mr. Troy Churchill
Title
Administrator
Phone
(239) 343-7300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X SNF1202096 FL Primary

Addresses

Primary practice location

16131 Roserush CT
Fort Myers, FL 33908-3634

Mailing address

16131 Roserush CT
Fort Myers, FL 33908-3634
Phone (239) 433-4647

Other identifiers 1

IdentifierTypeStateIssuer
021058700MedicaidFL

Other names 1

  • HealthPark Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031118000208 FL Part A Provider - Skilled Nursing Facility 9335053990 Practice locations: Fort Myers, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699786061. Details of each certification follow.

Skilled nursing facility certification: CCN 105779

Legal name
HEALTHPARK CARE CENTER, INC.
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 30, 1992
Last certification
Sep 21, 2023
Beds
112
Ownership / control type
Nonprofit Corporation
Organization structure
OtherNon-profit
Incorporated
Jan 1, 1992 in FL
Enrollment address
16131 Roserush CT
Fort Myers, FL 33908-3634
Nursing home name
HEALTHPARK CARE CENTER

Care Compare: Nursing home

Medicare Care Compare
Listed as
Healthpark Care CenterCCN 105779 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Dec 30, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
11297.6 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Ownership & related parties

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.

NameRoleSinceShare
David Collins Individual Corporate DirectorNA Nov 1, 2024
Lawrence R Antonucci Individual Corporate OfficerPresident, Ceo and Director Jun 1, 2017
Corporate DirectorPresident, Ceo and Director Nov 1, 2024
Jennifer Mahoney Individual Adp of the SNF Nov 1, 2024
Nancy McGovern Individual Corporate DirectorSecretary Nov 1, 2024
Julie Dewitt Individual Adp of the SNF Nov 1, 2024
Peter Andruszkiewicz Individual Corporate DirectorNA Jan 16, 2025
Diane Champion Individual Corporate DirectorNA Nov 1, 2024
Therese Everly Individual Corporate DirectorNA Nov 1, 2024
Samira Beckwith Individual Corporate DirectorDirector Aug 14, 2025
Leslie Vollmer Individual Operational/Managerial Control May 17, 2022
Adp of the SNF May 17, 2022
David Pryor Individual Corporate DirectorDirector Aug 14, 2025
Joeseph Catti Individual Corporate DirectorNA Jan 16, 2025
Kathy Bridge-Liles Individual Corporate DirectorNA Nov 1, 2024
David H Klein Individual Corporate DirectorNA Nov 1, 2024
Dane Allen Individual Corporate DirectorTreasurer Nov 1, 2024
William Gruver Individual Corporate DirectorNA Jan 16, 2025
Benjamin Spence Individual Operational/Managerial Control Jun 1, 2017
Adp of the SNF Jun 1, 2017
Stephen Brown Individual Corporate DirectorNA Nov 1, 2024
Knisha Williams Individual Operational/Managerial Control Nov 1, 2024
Adp of the SNF Nov 1, 2024
Donna Clarke Individual Corporate DirectorNA Nov 1, 2024
Lee Health System Inc Organization, Fort Myers, FL Corporation, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Nov 1, 2024 100%

Owners & managing parties with NPI records 12

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

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440547200000",
    "number": "1699786061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16131 ROSERUSH CT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339083634",
            "telephone_number": "239-433-4647",
            "fax_number": "239-432-3456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16131 ROSERUSH CT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339083634",
            "telephone_number": "239-433-4647",
            "fax_number": "239-432-3456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHPARK CARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2015-08-26",
        "status": "A",
        "authorized_official_last_name": "CHURCHILL",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "239-343-7300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1202096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021058700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthPark Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.