NPIMap

Organization Active NPI

Mansfield Long Term Care LLC

Doing business as The Pavilion at Creekwood

  • Skilled Nursing Facility
  • Mansfield, TX
National Provider Identifier
1710378575
Registry record updated Oct 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MANSFIELD LONG TERM CARE LLC
Doing business as
The Pavilion at Creekwood
Practice address
2100 Cannon Drive
Mansfield, TX 76063
Phone
(817) 779-6500
Fax
(817) 779-6501
NPI assigned
Feb 13, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2019

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

Authorized official

Name
Suzanne Meyer
Title
President
Phone
(817) 779-6500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

2100 Cannon Drive
Mansfield, TX 76063

Mailing address

920 Ridgebrook Rd
Sparks, MD 21152-9390
Phone (817) 779-6500

Other identifiers 1

IdentifierTypeStateIssuer
001026926MedicaidTX

Other names 1

  • The Pavilion at Creekwood Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150717000617 TX Part A Provider - Skilled Nursing Facility 9931412178 Practice locations: Mansfield, TX

Skilled nursing facility certification: CCN 676388

Legal name
MANSFIELD LONG TERM CARE, LLC
Doing business as
THE PAVILION AT CREEKWOOD
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Aug 3, 2015
Last certification
Feb 26, 2025
Beds
126
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Fundamental Healthcare
Organization structure
LLCProprietary
Enrollment address
2100 Cannon Dr
Mansfield, TX 76063-3476
Nursing home name
THE PAVILION AT CREEKWOOD
Affiliated entity
FUNDAMENTAL HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Pavilion at CreekwoodCCN 676388 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Aug 3, 2015
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12697.3 residents per day on average
Chain
Fundamental Healthcare66 facilities in the chain
Penalties (3 years)
3Fines totaling $39,674

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Camelia M Rigsby Individual Adp of the SNF Dec 1, 2016
Fundamental Clinical and Operational Services, LLC Organization, Sparks, MD LLC Adp of the SNF Jul 1, 2007
Murray Forman Individual 5% Or Greater Indirect Ownership Interest Mar 28, 2006 100%
Ryan K Leblanc Individual Corporate OfficerAdministrator/President Jan 1, 2022
Operational/Managerial Control Jan 1, 2022
Adp of the SNF Jan 1, 2022
Thi of Texas LLC Organization, North Richland Hills, TX LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 21, 2007 100%
Operational/Managerial Control Jun 21, 2007
Fundamental Administrative Services LLC Organization, Sparks, MD LLC Adp of the SNF Jul 1, 2007
Thi of Baltimore, Inc. Organization, Sparks, MD Corporation, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 1, 2007 100%
Hunt Valley Holdings LLC Organization, Sparks, MD LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 9, 2010 100%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 40

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

View all 40

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 4

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": "1423785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571270400000",
    "number": "1710378575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 RIDGEBROOK RD",
            "city": "SPARKS",
            "state": "MD",
            "postal_code": "211529390",
            "telephone_number": "817-779-6500",
            "fax_number": "817-779-6501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 CANNON DRIVE",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "76063",
            "telephone_number": "817-779-6500",
            "fax_number": "817-779-6501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANSFIELD LONG TERM CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-13",
        "last_updated": "2019-10-17",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-779-6500"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001026926",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Pavilion at Creekwood",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Pavilion at Creekwood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mansfield, TX

Sources for this page

Verify at the official NPI Registry.