NPIMap

Organization Active NPI

Nanticoke Rehabilitation and Healthcare LLC

  • Skilled Nursing Facility
  • Nanticoke, PA
National Provider Identifier
1750096293
Registry record updated Jan 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
NANTICOKE REHABILITATION AND HEALTHCARE LLC
Practice address
147 Old Newport St
Nanticoke, PA 18634-1327
Phone
(570) 735-7300
NPI assigned
Jan 19, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2023

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

Authorized official

Name
Shai Berdugo
Title
Authorized Official
Phone
(570) 735-7300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

147 Old Newport St
Nanticoke, PA 18634-1327

Mailing address

575 Route 70 FL 2
Brick, NJ 08723-4042

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230926002992 PA Part A Provider - Skilled Nursing Facility 5890149777 Practice locations: Nanticoke, PA

Skilled nursing facility certification: CCN 395298

Legal name
NANTICOKE REHABILITATION AND HEALTHCARE LLC
Doing business as
LAKEWOOD REHABILITATION & HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 5, 1972
Last certification
Jun 13, 2025
Beds
110
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
147 Old Newport St
Nanticoke, PA 18634-1327
Nursing home name
LAKEWOOD REHABILITATION & HEALTHCARE CENTER
Affiliated entity
CENTURY HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lakewood Rehabilitation & Healthcare CenterCCN 395298
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 5, 1972
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
110101.7 residents per day on average
Chain
Century Healthcare9 facilities in the chain
Penalties (3 years)
4Fines totaling $291,613

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
39D0863347Lakewood Rehabilitation & Healthcare Center147 Old Newport Street, Nanticoke, PA 18634Certificate of waiverJul 21, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Ralley LLC Organization, Brick, NJ LLC, For-profit Operational/Managerial Control May 1, 2023
Shai Berdugo Individual 5% Or Greater Indirect Ownership Interest Mar 4, 2025 47.33%
Corporate OfficerReimbursement Officer May 1, 2023
Operational/Managerial Control Mar 4, 2025
Adp of the SNF Mar 4, 2025
Brittany Shibak Individual Operational/Managerial Control Aug 19, 2024
Adp of the SNF Apr 7, 2026
Janusz F Wolanin Individual Operational/Managerial Control May 1, 2023
Adp of the SNF Apr 7, 2026
Century Pennsylvania Holdco LLC Organization, Brick, NJ LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest May 1, 2023 100%
Kulanu Oc Trust Organization, Lincolnwood, IL 5% Or Greater Indirect Ownership Interest May 1, 2023 14.5%
Century I TBD Holdco LLC Organization, Brick, NJ LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2023 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 8

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

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1674086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674086400000",
    "number": "1750096293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 ROUTE 70 FL 2",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087234042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 OLD NEWPORT ST",
            "city": "NANTICOKE",
            "state": "PA",
            "postal_code": "186341327",
            "telephone_number": "570-735-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NANTICOKE REHABILITATION AND HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-19",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A",
        "authorized_official_last_name": "BERDUGO",
        "authorized_official_first_name": "SHAI",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "570-735-7300"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nanticoke, PA

Sources for this page

Verify at the official NPI Registry.