Active NPI
Long Term Centers of Lexington Inc
- Skilled Nursing Facility
- Lexington, MA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 0205
- Legal business name
- LONG TERM CENTERS OF LEXINGTON INC
- Doing business as
- Pine Knoll Nursing Center
- Practice address
- 30 Watertown St
Lexington, MA 02421-6399 - Phone
- (781) 862-8151
- Fax
- (781) 862-3703
- NPI assigned
- Jan 6, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Thomas E Woods
- Title
- Administrator
- Phone
- (781) 862-8151
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 0205 | MA | Primary |
Addresses
Primary practice location
30 Watertown St
Lexington, MA 02421-6399
Mailing address
30 Watertown St
Lexington, MA 02421-6399
Phone (781) 862-8151
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0925799 | Medicaid | MA |
Other names 1
- Pine Knoll Nursing Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100108000205 | MA | Part A Provider - Skilled Nursing Facility | 2860582830 | Practice locations: Lexington, MA |
Skilled nursing facility certification: CCN 225049
- Legal name
- LONG TERM CENTERS OF LEXINGTON INC
- Doing business as
- PINE KNOLL NURSING CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 1967
- Last certification
- Sep 26, 2024
- Beds
- 81
- Ownership / control type
- Corporation
- Multi-facility organization
- Long Term Centers of New England, Inc.
- Organization structure
- Corporation
- Incorporated
- Dec 1, 1999 in MA
- Enrollment address
- 30 Watertown St
Lexington, MA 02421-6331 - Nursing home name
- PINE KNOLL NURSING CENTER
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Pine Knoll Nursing Center
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jan 1, 1967
- Medicare certification status
- Active
- Certified beds
- 81
- Special focus status
- SFF
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 3
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 22D0725098 | Pine Knoll Nursing Center | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 4
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Thomas E Woods | 5% Or Greater Direct Ownership Interest | Jul 25, 2024 | 75% |
| Corporate Officer | Dec 1, 1999 | 75% | |
| Operational/Managerial Control | May 1, 2018 | ||
| Adp of the SNF | May 1, 2018 | ||
| Matthew J Sweeney | 5% Or Greater Direct Ownership Interest | Jul 25, 2024 | 25% |
| Corporate Officer | Jul 31, 2024 | 25% | |
| Operational/Managerial Control | May 1, 2018 | ||
| Adp of the SNF | May 1, 2018 | ||
| Asif Merchant | Operational/Managerial Control | Jan 1, 2014 | |
| Adp of the SNF | Jan 1, 2014 | ||
| Jessica Gouveia | Operational/Managerial Control | Aug 1, 2024 | |
| Adp of the SNF | Aug 1, 2024 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Geriatric Medicine (Internal Medicine) Physician
- Chelmsford, MA
- NPI 1538152335
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Geriatric Medicine (Internal Medicine) Physician
- Chelmsford, MA
- NPI 1538152335
-
- Family Medicine Physician
- Holliston, MA
- NPI 1801093356
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136505600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1262736000000",
"number": "1730167990",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 WATERTOWN ST",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "024216399",
"telephone_number": "781-862-8151",
"fax_number": "781-862-3703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 WATERTOWN ST",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "024216399",
"telephone_number": "781-862-8151",
"fax_number": "781-862-3703"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LONG TERM CENTERS OF LEXINGTON INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-01-06",
"last_updated": "2010-01-06",
"status": "A",
"authorized_official_last_name": "WOODS",
"authorized_official_first_name": "THOMAS",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "781-862-8151"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "MA",
"license": "0205",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0925799",
"state": "MA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Pine Knoll Nursing Center",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Lexington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.