NPIMap

Organization Active NPI

Surrey Place Nursing Center LLC

  • Skilled Nursing Facility
  • Live Oak, FL
National Provider Identifier
1730815226
Registry record updated Jul 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SURREY PLACE NURSING CENTER LLC
Doing business as
Surrey Place Nursing Center
Practice address
110 Lee Ave SE
Live Oak, FL 32064-9504
Phone
(386) 364-5961
NPI assigned
Jul 27, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2022

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

Authorized official

Name
Mayer Fischl
Title
Cfo
Phone
(718) 757-6399

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

110 Lee Ave SE
Live Oak, FL 32064-9504

Mailing address

110 Lee Ave SE
Live Oak, FL 32064-9504

Other names 1

  • Surrey Place Nursing Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221116002606 FL Part A Provider - Skilled Nursing Facility 4981072352 Practice locations: Live Oak, FL

Skilled nursing facility certification: CCN 105597

Legal name
SURREY PLACE NURSING CENTER LLC
Doing business as
SURREY PLACE NURSING CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jan 21, 1988
Last certification
Jul 3, 2024
Beds
60
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Harborview Health Systems
Organization structure
LLCProprietary
Incorporated
Jul 7, 2022 in FL
Enrollment address
110 Lee Ave SE
Live Oak, FL 32064-9504
Nursing home name
SURREY PLACE NURSING CENTER
Affiliated entity
BENJAMIN LANDA

Care Compare: Nursing home

Medicare Care Compare
Listed as
Surrey Place Nursing CenterCCN 105597 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 21, 1988
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6054.0 residents per day on average
Chain
Benjamin Landa48 facilities in the chain

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
Mayer Fischel Individual 5% Or Greater Indirect Ownership Interest Oct 8, 2022 10%
ZBL-18 LLC Organization, Brooklyn, NY Created for acquisition, LLC, For-profit 5% Or Greater Indirect Ownership Interest Oct 8, 2022 10%
Surrey Place Nursing Center LLC Organization, Live Oak, FL Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Oct 7, 2022 100%
Mathew K Varghese Individual 5% Or Greater Indirect Ownership Interest Oct 8, 2022 10%
Premier 4 Opco Partners LLC Organization, Richmond, KY Created for acquisition, LLC, For-profit 5% Or Greater Indirect Ownership Interest Oct 8, 2022 100%
Deborah a Stone Individual W-2 Managing EmployeeAdministrator Oct 8, 2022 100%
Benjamin Landa Individual 5% Or Greater Indirect Ownership Interest Oct 8, 2022 70%
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 70%

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 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": "1658880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658880000000",
    "number": "1730815226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 LEE AVE SE",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320649504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 LEE AVE SE",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320649504",
            "telephone_number": "386-364-5961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURREY PLACE NURSING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-27",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A",
        "authorized_official_last_name": "FISCHL",
        "authorized_official_first_name": "MAYER",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "718-757-6399"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surrey Place Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Live Oak, FL

Sources for this page

Verify at the official NPI Registry.