NPIMap

Organization Active NPI

Old Southwest Health and Rehabilitation LLC

Doing business as Old Southwest Health and Rehabilitation

  • Skilled Nursing Facility
  • Roanoke, VA
National Provider Identifier
1750094033
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
OLD SOUTHWEST HEALTH AND REHABILITATION LLC
Doing business as
Old Southwest Health and Rehabilitation
Practice address
324 King George Ave SW
Roanoke, VA 24016-5213
Phone
(540) 345-8139
NPI assigned
Jan 2, 2023
Last updated
Mar 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Authorized official

Name
Akiva Shapiro
Title
Coo
Phone
(201) 581-6622

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

324 King George Ave SW
Roanoke, VA 24016-5213

Mailing address

324 King George Ave SW
Roanoke, VA 24016-5213
Phone (540) 345-8139

Other names 1

  • Old Southwest Health and Rehabilitation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240329002049 VA Part A Provider - Skilled Nursing Facility 7012355878 Practice locations: Roanoke, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750094033. Details of each certification follow.

Skilled nursing facility certification: CCN 495156

Legal name
OLD SOUTHWEST HEALTH AND REHABILITATION LLC
Doing business as
OLD SOUTHWEST HEALTH AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 25, 1985
Last certification
Mar 29, 2024
Beds
130
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
Feb 1, 2024
Organization structure
LLCProprietary
Incorporated
Nov 30, 2022 in VA
Enrollment address
324 King George Ave SW
Roanoke, VA 24016-5213
Nursing home name
OLD SOUTHWEST HEALTH AND REHABILITATION
Affiliated entity
EASTERN HEALTHCARE GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Old Southwest Health and RehabilitationCCN 495156 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
2 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Apr 25, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
13076.5 residents per day on average
Chain
Eastern Healthcare Group18 facilities in the chain
Penalties (3 years)
2Fines totaling $135,633

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
49D0890659Old Southwest Health and Rehabilitation LLC324 King George Ave SW, Roanoke, VA 24016Certificate of waiverSep 14, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Ydi Irrevocable Trust Organization, Clifton, NJ LLC, For-profit 5% Or Greater Indirect Ownership Interest Feb 1, 2024 100%
Ydi Eastern Holdco LLC Organization, Montvale, NJ LLC, For-profit 5% Or Greater Indirect Ownership Interest Feb 1, 2024 50%
Akiva Shapiro Individual Corporate OfficerCoo Feb 1, 2024
Other Feb 1, 2024
JJ United TR Organization, Clifton, NJ For-profit 5% Or Greater Indirect Ownership Interest Feb 1, 2024 50%
VA SNF Operations Holdings 2 LLC Organization, Montvale, NJ LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Feb 1, 2024 100%
Andrew Shuler Individual W-2 Managing EmployeeAdministrator Feb 1, 2024

Facilities with the same owner 17

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

View all 17

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1672617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1750094033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 KING GEORGE AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240165213",
            "telephone_number": "540-345-8139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 KING GEORGE AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240165213",
            "telephone_number": "540-345-8139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD SOUTHWEST HEALTH AND REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-02",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A",
        "authorized_official_last_name": "SHAPIRO",
        "authorized_official_first_name": "AKIVA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "201-581-6622"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Old Southwest Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Old Southwest Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.