NPIMap

Organization Active NPI

College Park Rehabilitation and Nursing Center LLC

  • Pediatric Skilled Nursing Facility
  • Fort Myers, FL
National Provider Identifier
1720714348
Registry record updated Aug 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Skilled Nursing FacilityTaxonomy code 3140N1450X
Legal business name
COLLEGE PARK REHABILITATION AND NURSING CENTER LLC
Practice address
13755 Golf Club Pkwy
Fort Myers, FL 33919-5146
Phone
(239) 482-2848
NPI assigned
Jul 26, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2022

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

Authorized official

Name
Joel Leifer
Title
Ceo
Phone
(718) 705-6740

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Skilled Nursing Facility 3140N1450X Primary

Addresses

Primary practice location

13755 Golf Club Pkwy
Fort Myers, FL 33919-5146

Mailing address

13755 Golf Club Pkwy
Fort Myers, FL 33919-5146
Phone (239) 482-2848

Other identifiers 1

IdentifierTypeStateIssuer
1159096OtherFLLICENSE

Other names 1

  • Ambassador Healthcare at College Park Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://shcatcollegepark.com/ Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221119000464 FL Part A Provider - Skilled Nursing Facility 4789052911 Practice locations: Fort Myers, FL

Skilled nursing facility certification: CCN 105387

Legal name
COLLEGE PARK REHABILITATION AND NURSING CENTER LLC
Doing business as
AMBASSADOR HEALTHCARE AT COLLEGE PARK
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 27, 1981
Last certification
Jan 11, 2024
Beds
107
Ownership / control type
Corporation
Multi-facility organization
Excelsior Care Group
Organization structure
LLCProprietary
Incorporated
Jul 7, 2022 in FL
Enrollment address
13755 Golf Club Pkwy
Fort Myers, FL 33919-5146
Nursing home name
AMBASSADOR HEALTHCARE AT COLLEGE PARK
Affiliated entity
EXCELSIOR CARE GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Ambassador Healthcare at College ParkCCN 105387
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jul 27, 1981
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10794.9 residents per day on average
Chain
Excelsior Care Group33 facilities in the chain
Penalties (3 years)
2Fines totaling $96,105

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
10D1081126Ambassador Healthcare at College Park13755 Golf Club Pkwy, Fort Myers, FL 33919Certificate of waiverDec 5, 2027

National Provider Directory

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 Maximo (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 7

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

NameRoleSinceShare
Cheskel David Berkowitz Individual 5% Or Greater Indirect Ownership Interest Oct 8, 2022 30%
College Park Rehabilitation and Nursing Center LLC Organization, Fort Myers, FL Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Oct 7, 2022 100%
Benjamin Johnson Individual W-2 Managing EmployeeAdministrator Nov 1, 2022 100%
Joel Zupnick Individual 5% Or Greater Indirect Ownership Interest Oct 8, 2022 30%
Benjamin Landa Individual 5% Or Greater Indirect Ownership Interest Oct 8, 2022 10%
Joel Leifer Individual 5% Or Greater Indirect Ownership Interest Oct 8, 2022 30%
Corporate Officer Oct 8, 2022 100%
Flnho Capital Group LLC Organization, Mineola, NY LLC, For-profit 5% Or Greater Indirect Ownership Interest Oct 8, 2022 10%

Facilities with the same owner 29

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

View all 29

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1658793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661904000000",
    "number": "1720714348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13755 GOLF CLUB PKWY",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339195146",
            "telephone_number": "239-482-2848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13755 GOLF CLUB PKWY",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339195146",
            "telephone_number": "239-482-2848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEGE PARK REHABILITATION AND NURSING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-26",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A",
        "authorized_official_last_name": "LEIFER",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "718-705-6740"
    },
    "taxonomies": [
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "1159096",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://shcatcollegepark.com/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "13755 Golf Club Pkwy",
            "city": "Fort Myers",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339195146",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Ambassador Healthcare at College Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.