620 Tom Hunter Road Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

620 TOM HUNTER ROAD OPCO LLC

Practice address

620 Tom Hunter Rd
Charlotte, NC 28213-5511

Phone

(704) 598-5136

Fax

(704) 598-5167

NPI assigned

Dec 23, 2024

Organization subpart

No

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

Authorized official

Name

Tiffany Hoback

Title

Manager

Phone

(770) 698-9040

Specialties & licenses 1

Addresses

Other names 1

• Crown Haven Health and Rehabilitation Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Skilled nursing facility certification: CCN 345388

Legal name

620 TOM HUNTER ROAD OPCO LLC

Doing business as

CROWN HAVEN HEALTH AND REHABILITATION

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jun 26, 1991

Last certification

Feb 12, 2024

Beds

120

Ownership / control type

Limited Liability Corporation

Organization structure

LLC

Enrollment address

620 Tom Hunter Rd
Charlotte, NC 28213-5511

Nursing home name

CROWN HAVEN HEALTH AND REHABILITATION

Affiliated entity

AVARDIS HEALTH

Listed as

Crown Haven Health and RehabilitationCCN 345388

Overall star rating

2 of 5

Health inspections

1 of 5

Staffing

2 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jun 26, 1991

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

12091.9 residents per day on average

Chain

Avardis Health38 facilities in the chain

Penalties (3 years)

5Fines totaling $71,235

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 20

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

Owners & managing parties with NPI records 1

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

• Waseem Ghannam

  • Family Medicine Physician
  • Pineville, NC
  • NPI 1306080510

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 41

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

• 1000 Tandall Place Opco LLC

  • Skilled Nursing Facility
  • Knightdale, NC
  • NPI 1790593648

  SNF MGR LLC

  CMS ownership
• 1810 Concord Lake Road Opco LLC

  • Skilled Nursing Facility
  • Kannapolis, NC
  • NPI 1114735156

  SNF MGR LLC

  CMS ownership
• 2030 Harper Avenue Opco LLC

  • Skilled Nursing Facility
  • Lenoir, NC
  • NPI 1497563431

  SNF MGR LLC

  CMS ownership
• 25 Reynolds Mountain Boulevard Opco LLC

  • Skilled Nursing Facility
  • Asheville, NC
  • NPI 1548078652

  SNF MGR LLC

  CMS ownership
• 333 East Lee Avenue Opco LLC

  • Skilled Nursing Facility
  • Yadkinville, NC
  • NPI 1669280517

  SNF MGR LLC

  CMS ownership
• 3864 Sweeten Creek Road Opco LLC

  • Skilled Nursing Facility
  • Arden, NC
  • NPI 1548078595

  SNF MGR LLC

  CMS ownership
• 511 Windmill Street Opco LLC

  • Skilled Nursing Facility
  • Walnut Cove, NC
  • NPI 1164230017

  SNF MGR LLC

  CMS ownership
• 518 Old US Highway 221 Opco LLC

  • Skilled Nursing Facility
  • Rutherfordton, NC
  • NPI 1427866474

  SNF MGR LLC

  CMS ownership
• 551 Kent Street Opco LLC

  • Skilled Nursing Facility
  • Andrews, NC
  • NPI 1437967387

  SNF MGR LLC

  CMS ownership
• 6001 Wilora Lake Road Opco LLC

  • Skilled Nursing Facility
  • Charlotte, NC
  • NPI 1831907781

  SNF MGR LLC

  CMS ownership
• 620 Heathwood Drive Opco LLC

  • Skilled Nursing Facility
  • Albemarle, NC
  • NPI 1316755424

  SNF MGR LLC

  CMS ownership
• 625 Ashland Street Opco LLC

  • Skilled Nursing Facility
  • Archdale, NC
  • NPI 1427866375

  SNF MGR LLC

  CMS ownership

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Waseem Ghannam

  • Family Medicine Physician
  • Pineville, NC
  • NPI 1306080510

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1734912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741564800000",
    "number": "1760290704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 TOM HUNTER RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282135511",
            "telephone_number": "704-598-5136",
            "fax_number": "704-598-5167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 TOM HUNTER RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282135511",
            "telephone_number": "704-598-5136",
            "fax_number": "704-598-5167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "620 TOM HUNTER ROAD OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-23",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A",
        "authorized_official_last_name": "HOBACK",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-698-9040"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.5042",
            "affiliationName": "Synergy Healthcare Services",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "850 Concourse Pkwy S Ste 250",
            "city": "Maitland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327516155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Crown Haven Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Skilled Nursing Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2025; 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.

Verify at the official NPI Registry.