Burgundi Manor Operating Company, LLC
Organization Active NPI Skilled Nursing Facility · Youngstown, OH
NPI 1760419915 · NPPES record last updated Jul 14, 2016
Key facts
- NPI
- 1760419915
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 2232N (OH)
- Legal business name
- BURGUNDI MANOR OPERATING COMPANY, LLC
- Practice address
- 31 Marantha Drive
Youngstown, OH 44505-4505 - Phone
- (330) 746-5157
- Fax
- (330) 746-2508
- NPI assigned
- Jun 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Paul B. Bergsten
- Title
- Ceo
- Phone
- (937) 825-6622
Facilities with the same owner 9
Practitioners 1
Affiliated clinicians 1
Medicare Care Compare: Nursing home
- Listed as
- Lincoln Knolls Health & Rehab LLC
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jan 5, 1991
- Medicare certification status
- Active
- Certified beds
- 62 · 37.7 residents per day on average
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Skilled nursing facility certification: CCN 365831
- Legal name
- BURGUNDI MANOR OPERATING COMPANY LLC
- Doing business as
- DANBRIDGE'S BURGUNDI MANOR
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 5, 1991
- Last certification
- Mar 21, 2024
- Beds
- 62
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- RISE Healthcare
- Organization structure
- LLC · Proprietary
- Incorporated
- Nov 4, 2010 in OH
- Enrollment address
- 31 Maranatha CT
Youngstown, OH 44505-4970
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Lucinda O'Hara |
W-2 Managing Employee |
Aug 3, 2021 | |
| Paul B Bergsten |
5% Or Greater Indirect Ownership Interest | Mar 28, 2016 | 60% |
| Corporate Officer |
Mar 28, 2016 | ||
| Matthew Dapore |
5% Or Greater Indirect Ownership Interest | Mar 28, 2016 | 40% |
| Corporate Officer |
Mar 28, 2016 | ||
| Hillstone Healthcare Inc. |
5% Or Greater Direct Ownership Interest | Sep 1, 2017 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101217000220 | OH | Part a Provider - Skilled Nursing Facility | 3678761608 | Practice locations: Youngstown, OH |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 2232NH | OH | |
| Skilled Nursing Facility | 314000000X | 2232N | OH | Yes |
Addresses
Primary practice location
31 Marantha Drive
Youngstown, OH 44505-4505
Mailing address
31 Maranatha CT
Youngstown, OH 44505-4970
Phone (330) 746-5157
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0364950001 | Other | OH | DEMERC |
| 3102127 | Medicaid | OH | |
| 2089396 | Medicaid | OH |
Other names
- Danridge's Burgundi Manor
Other providers in Youngstown, OH
- Brendan Burdette
- Molly Burdette
- Burdman Group, Inc.
- Jonathan William Burgei
- Constance Burgess
- Teresa Burk
- Amy C Burke
- Michael Burke
- Michael Jay Burkett
- Lynn Jay Burkey
All providers in Youngstown, OH · Skilled Nursing Facility in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.