NPIMap

Organization Active NPI

VJJ Holding Company, LLC

Doing business as Allegria Nursing & Rehabilitation Center of Port Jefferson

  • Skilled Nursing Facility
  • Port Jefferson Station, NY
National Provider Identifier
1780973347
Registry record updated Dec 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
5151316N Issued in NY
Legal business name
VJJ HOLDING COMPANY, LLC
Doing business as
Allegria Nursing & Rehabilitation Center of Port Jefferson
Practice address
1360 Route 112
Port Jefferson Station, NY 11776-3078
Phone
(631) 473-7100
Fax
(631) 473-7118
NPI assigned
Apr 5, 2011
Last updated
Dec 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2023

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

Authorized official

Name
Mrs. Melissa Catena Modica
Title
Administrator
Phone
(631) 473-7100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 5151316N NY Primary

Addresses

Primary practice location

1360 Route 112
Port Jefferson Station, NY 11776-3078

Mailing address

1360 Route 112
Port Jefferson Station, NY 11776-3078
Phone (631) 473-7100

Other identifiers 1

IdentifierTypeStateIssuer
00308470MedicaidNY

Other names 1

  • Allegria Nursing & Rehabilitation Center of Port Jefferson Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170208001635 NY Part A Provider - Skilled Nursing Facility 4183756406 Practice locations: Port Jefferson Station, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780973347. Details of each certification follow.

Skilled nursing facility certification: CCN 335514001

Legal name
VJJ HOLDING COMPANY LLC
Doing business as
WOODHAVEN NURSING HOME
Organization structure
LLCProprietary
Incorporated
Mar 10, 2009 in NY
Enrollment address
1360 Route 112
Port Jefferson Station, NY 11776-3078
Nursing home name
ALLEGRIA NURSING & REHAB CENTER OF PORT JEFFERSON

National Provider Directory

National Provider Directory

Locations

1360 Route 112
Port Jefferson Station, NY 11776
Phone (631) 473-3304

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Vanessa L Salzman Individual 5% Or Greater Direct Ownership Interest Apr 1, 2009 50%
Corporate Officer Apr 1, 2009 50%
Julianna L Gaul Individual 5% Or Greater Direct Ownership Interest Apr 1, 2009 50%
Corporate Officer Apr 1, 2009 50%
Kenneth E Gaul Individual W-2 Managing EmployeeAdministrator of Record Apr 1, 2009 100%

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1301961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703116800000",
    "number": "1780973347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1360 ROUTE 112",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763078",
            "telephone_number": "631-473-7100",
            "fax_number": "631-473-7118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 ROUTE 112",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763078",
            "telephone_number": "631-473-7100",
            "fax_number": "631-473-7118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VJJ HOLDING COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-05",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A",
        "authorized_official_last_name": "MODICA",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "CATENA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "631-473-7100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "5151316N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00308470",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allegria Nursing & Rehabilitation Center of Port Jefferson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Jefferson Station, NY

Sources for this page

Verify at the official NPI Registry.