Active NPI
St. Petersburg Nursing and Rehabilitation, LLC
- Skilled Nursing Facility
- St Petersburg, FL
National Provider Identifier
1730556739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- ST. PETERSBURG NURSING AND REHABILITATION, LLC
- Practice address
- 521 69TH Ave N
St Petersburg, FL 33702-6801 - Phone
- (727) 526-7000
- NPI assigned
- Aug 25, 2015
- Last updated
- Aug 25, 2015
- 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
- Moshe David Aryeh
- Title
- Principal
- Phone
- (773) 793-0167
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | FL | Primary |
Addresses
Primary practice location
521 69TH Ave N
St Petersburg, FL 33702-6801
Mailing address
7383 N Lincoln Ave
Suite 100
Lincolnwood, IL 60712-1734
Phone (847) 440-2233
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160513000145 | FL | Part A Provider - Skilled Nursing Facility | 9537458674 | Practice locations: St Petersburg, FL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1730556739. Details of each certification follow.
Skilled nursing facility certification: CCN 106033
- Legal name
- ST. PETERSBURG NURSING AND REHABILITATION, LLC
- Doing business as
- ST. PETERSBURG NURSING & REHABILITATION
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Sep 6, 2000
- Last certification
- Feb 16, 2023
- Beds
- 96
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Vivo Healthcare
- Organization structure
- LLC
- Incorporated
- Aug 11, 2015 in FL
- Enrollment address
- 521 Atwood Ave N
St Petersburg, FL 33702-6810 - Nursing home name
- VIVO HEALTHCARE ST PETERSBURG
- Affiliated entity
- VIVO HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Vivo Healthcare St Petersburg
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Sep 6, 2000
- Medicare certification status
- Active
- Certified beds
- 96
- Chain
- Vivo Healthcare
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 |
|---|---|---|---|
| 10D0954841 | St Petersburg Nursing & Rehabilitation LLC | Certificate of waiver | Oct 10, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- Palm Terrace of St Petersburg
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Palm Terrace of St. Petersburg
- Skilled Nursing Facility
- St Petersburg, FL
- NPI 1134125362
Locations
400 Rella Blvd
Ste 200
Suffern, NY 10901
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Ownership & related parties
All disclosed owners & managing parties 10
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 |
|---|---|---|---|
| Zaidys LLC | 5% Or Greater Indirect Ownership Interest | Nov 16, 2017 | 30% |
| Allegiant Healthcare of Florida LLC | 5% Or Greater Indirect Ownership Interest | Nov 16, 2017 | 60% |
| Samuel Goldner | 5% Or Greater Indirect Ownership Interest | Nov 16, 2017 | 30% |
| Ronald Tencza | W-2 Managing Employee | Nov 16, 2017 | 100% |
| Solomon Vizcaya Holdings LLC | 5% Or Greater Indirect Ownership Interest | Nov 16, 2017 | 30% |
| Asmsy LLC | 5% Or Greater Indirect Ownership Interest | Nov 16, 2017 | 30% |
| Irving Langer 2014 Family Trust U/T/a | 5% Or Greater Indirect Ownership Interest | Nov 16, 2017 | 30% |
| Jacob Karmel | 5% Or Greater Indirect Ownership Interest | Nov 16, 2017 | 10% |
| Palm Terrace J Dek Operations LLC | 5% Or Greater Direct Ownership Interest | Mar 31, 2016 | 100% |
| Ariel S Fein | 5% Or Greater Indirect Ownership Interest | Nov 16, 2017 | 28.5% |
Facilities with the same owner 2
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Skilled Nursing Facility
- Clewiston, FL
- NPI 1174999478
Allegiant Healthcare of Florida LLC, Asmsy LLC, Irving Langer 2014 Family Trust U/T/a, Palm Terrace J Dek Operations LLC, Solomon Vizcaya Holdings LLC, Zaidys LLC
-
- Skilled Nursing Facility
- Lakeland, FL
- NPI 1174999726
Allegiant Healthcare of Florida LLC, Asmsy LLC, Irving Langer 2014 Family Trust U/T/a, Palm Terrace J Dek Operations LLC, Solomon Vizcaya Holdings LLC, Zaidys LLC
Practitioners & affiliated clinicians
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": "1440460800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1440460800000",
"number": "1730556739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7383 N LINCOLN AVE",
"address_2": "SUITE 100",
"city": "LINCOLNWOOD",
"state": "IL",
"postal_code": "607121734",
"telephone_number": "847-440-2233"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "521 69TH AVE N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337026801",
"telephone_number": "727-526-7000"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST. PETERSBURG NURSING AND REHABILITATION, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-08-25",
"last_updated": "2015-08-25",
"status": "A",
"authorized_official_last_name": "ARYEH",
"authorized_official_first_name": "MOSHE",
"authorized_official_middle_name": "DAVID",
"authorized_official_title_or_position": "PRINCIPAL",
"authorized_official_telephone_number": "773-793-0167"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "FL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
- St. Petersburg Dermatology, LLC
- St. Petersburg Endoscopy Center LLC
- St. Petersburg Free Clinic
- St. Petersburg General Hospital
- St. Petersburg General Surgery LLC
- St. Petersburg Nutrition LLC
- St. Petersburg Operator LLC (Brentwood Senior Living at St. Pete)
- St. Petersburg Outpatient Surgery Center, LLC (St. Petersburg Eye Surgery Center)
- St. Petersburg Primary Care Associates
- St. Petersburg Surgical Specialist
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2015; 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.