Organization Active NPI

Roseville Mi Opco LLC

  • Skilled Nursing Facility
  • Roseville, MI
National Provider Identifier
1780356303
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
ROSEVILLE MI OPCO LLC
Practice address
25375 Kelly Rd
Roseville, MI 48066-4960
Phone
(718) 838-1501
NPI assigned
Oct 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Authorized official

Name
Rob Korn
Title
Manager
Phone
(718) 838-1501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

25375 Kelly Rd
Roseville, MI 48066-4960

Mailing address

362 E Kennedy Blvd
Lakewood, NJ 08701-1434

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211116000991 MI Part A Provider - Skilled Nursing Facility 2769871698 Practice locations: Roseville, MI

Skilled nursing facility certification: CCN 235491

Legal name
ROSEVILLE MI OPCO LLC
Doing business as
THE ORCHARDS AT ROSEVILLE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Oct 6, 1989
Last certification
Apr 30, 2025
Beds
169
Ownership / control type
Corporation
Most recent change of ownership
Jan 1, 2015
Organization structure
LLCProprietary
Incorporated
Jul 20, 2021 in MI
Enrollment address
25375 Kelly Rd
Roseville, MI 48066-4960
Nursing home name
THE ORCHARDS AT ROSEVILLE
Affiliated entity
THE ORCHARDS MICHIGAN

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Orchards at RosevilleCCN 235491
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Oct 6, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
169119.3 residents per day on average
Chain
The Orchards Michigan15 facilities in the chain

Processed by Care Compare on Aug 1, 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
Isaac Gutman Individual 5% Or Greater Direct Ownership Interest Nov 1, 2021 30%
Jacob Taub Individual 5% Or Greater Direct Ownership Interest Nov 1, 2021 30%
Peter John Brogger Individual W-2 Managing EmployeeAdministrator Nov 1, 2021
Alexander Hoffman Individual 5% Or Greater Direct Ownership Interest Nov 1, 2021 30%
Jason Williams Individual W-2 Managing EmployeeDirector of Nursing Nov 1, 2021
Robert Kornfeld Individual 5% Or Greater Direct Ownership Interest Nov 1, 2021 10%

Practitioners & affiliated clinicians

Practitioners 5

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

Affiliated clinicians 4

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": "1633046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1780356303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "362 E KENNEDY BLVD",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087011434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25375 KELLY RD",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664960",
            "telephone_number": "718-838-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSEVILLE MI OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-01",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "KORN",
        "authorized_official_first_name": "ROB",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "718-838-1501"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MI

Sources for this page

Verify at the official NPI Registry.