Active NPI
Crescent Cities SNF LLC
- Skilled Nursing Facility
- Riverdale, MD
National Provider Identifier
1740759463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- CRESCENT CITIES SNF LLC
- Practice address
- 4409 E West Hwy
Riverdale, MD 20737-1058 - Phone
- (301) 699-2000
- NPI assigned
- Nov 26, 2018
- Last updated
- Nov 26, 2018
- 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
- Israel Birnbaum
- Title
- Authorized Rep
- Phone
- (732) 905-6440
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
4409 E West Hwy
Riverdale, MD 20737-1058
Mailing address
4409 E West Hwy
Riverdale, MD 20737-1058
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190218001195 | MD | Part A Provider - Skilled Nursing Facility | 1355689332 | Practice locations: Riverdale, MD |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1740759463. Details of each certification follow.
Skilled nursing facility certification: CCN 215323
- Legal name
- CRESCENT CITIES SNF LLC
- Doing business as
- CRESCENT CITIES NURSING AND REHABILITATION CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Apr 14, 1999
- Last certification
- Nov 14, 2024
- Beds
- 158
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Incorporated
- Oct 23, 2018 in MD
- Enrollment address
- 4409 E West Hwy
Riverdale, MD 20737-1058 - Nursing home name
- CRESCENT CITIES NURSING & REHABILITATION CENTER
- Affiliated entity
- LIFEWORKS REHAB
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Crescent Cities Nursing & Rehabilitation Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Apr 14, 1999
- Medicare certification status
- Active
- Certified beds
- 158
- Chain
- Lifeworks Rehab
- Penalties (3 years)
- 1
National Provider Directory
National Provider Directory- Tax ID family
- Crescent Cities Nursing Rehab Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Physical Therapist
- Riverdale, MD
- NPI 1285190520
Ownership & related parties
All disclosed owners & managing parties 5
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 |
|---|---|---|---|
| Forest Holdings | 5% Or Greater Indirect Ownership Interest | Feb 1, 2019 | 10% |
| Avrohom Y Kohn | 5% Or Greater Indirect Ownership Interest | May 1, 2021 | 44.74% |
| Israel M Birnbaum | 5% Or Greater Indirect Ownership Interest | May 1, 2021 | 22.37% |
| W-2 Managing Employee | May 1, 2021 | ||
| Michele Netzer | 5% Or Greater Indirect Ownership Interest | May 1, 2021 | 22.37% |
| Crescent Cities Health Holdco LLC | 5% Or Greater Direct Ownership Interest | Feb 1, 2019 | 100% |
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Internal Medicine Physician
- Clinton, MD
- NPI 1649224643
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": "1543190400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1543190400000",
"number": "1740759463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4409 E WEST HWY",
"city": "RIVERDALE",
"state": "MD",
"postal_code": "207371058"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4409 E WEST HWY",
"city": "RIVERDALE",
"state": "MD",
"postal_code": "207371058",
"telephone_number": "301-699-2000"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CRESCENT CITIES SNF LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-11-26",
"last_updated": "2018-11-26",
"status": "A",
"authorized_official_last_name": "BIRNBAUM",
"authorized_official_first_name": "ISRAEL",
"authorized_official_title_or_position": "AUTHORIZED REP",
"authorized_official_telephone_number": "732-905-6440"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverdale, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2018; 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.