NPIMap

Organization Active NPI

Park Lane Post Acute LLC

  • Skilled Nursing Facility
  • West Chester, PA
National Provider Identifier
1780426809
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PARK LANE POST ACUTE LLC
Practice address
1615 E Boot Rd
West Chester, PA 19380-6005
Phone
(610) 436-6663
NPI assigned
Jun 10, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

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

Authorized official

Name
Moss Ellenbogen
Title
Authorized Official
Phone
(845) 490-6060

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1615 E Boot Rd
West Chester, PA 19380-6005

Mailing address

1615 E Boot Rd
West Chester, PA 19380-6005
Phone (610) 436-6663

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250402001225 PA Part A Provider - Skilled Nursing Facility 0840713608 Practice locations: West Chester, PA

Skilled nursing facility certification: CCN 396082

Legal name
PARK LANE POST ACUTE LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Nov 27, 2002
Last certification
May 16, 2025
Beds
68
Ownership / control type
Corporation
Multi-facility organization
Prestige Healthcare
Organization structure
LLCProprietary
Incorporated
Feb 28, 2024 in DE
Enrollment address
1619 E Boot Rd
West Chester, PA 19380-6005
Nursing home name
PARK LANE POST ACUTE LLC
Affiliated entity
PRESTIGE HEALTHCARE ADMINISTRATIVE SERVICES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Park Lane Post Acute LLCCCN 396082
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare
Ownership
For profit - Corporation
Certified
Nov 27, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6863.6 residents per day on average
Chain
Prestige Healthcare Administrative Services15 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 14

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

NameRoleSinceShare
Copper de Trust Organization, Miami, FL Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 17, 2024 10%
Plpa Holdings LLC Organization, Howell, NJ Created for acquisition, LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 17, 2024 100%
Silver de Trust Organization, Miami, FL Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 17, 2024 27.5%
Star PA I Holdings LLC Organization, Howell, NJ LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 17, 2024 20%
Organization, Lakewood, NJ LLC, Owned by another organization or individual Indirect Ownership Interest Jun 17, 2024
Moss M Ellenbogen Individual Corporate DirectorPresident Jun 17, 2024 100%
Aysan TR Organization, Miami, FL Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 17, 2024 5%
Individual Indirect Ownership Interest Jun 17, 2024
John N Huyette Individual Operational/Managerial Control Jun 17, 2024
Adp of the SNF Feb 14, 2025
Star PA I Trust Organization, Lakewood, NJ Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 17, 2024 20%
Gold de Trust Organization, Miami, FL Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 17, 2024 27.5%
PA & de Noble Parentco LLC Organization, Montebello, NY LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 17, 2024 75.01%
Buah MD Trust Organization, Miami, FL Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 17, 2024 5%
Jonathon Hykes Individual Operational/Managerial Control Jun 17, 2024
Adp of the SNF Feb 3, 2025

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 7

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

Practitioners & affiliated clinicians

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": "1717977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1780426809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 E BOOT RD",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193806005",
            "telephone_number": "610-436-6663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 E BOOT RD",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193806005",
            "telephone_number": "610-436-6663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK LANE POST ACUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "ELLENBOGEN",
        "authorized_official_first_name": "MOSS",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "845-490-6060"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Chester, PA

Sources for this page

Verify at the official NPI Registry.