NPIMap

Organization Active NPI

Williston Nursing and Rehab LLC

  • Skilled Nursing Facility
  • Williston, FL
National Provider Identifier
1811645260
Registry record updated Mar 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WILLISTON NURSING AND REHAB LLC
Practice address
300 NW 1St Ave
Williston, FL 32696-2006
Phone
(352) 528-3561
NPI assigned
Mar 15, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2022

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

Authorized official

Name
Moshe Scheiner
Title
Authorized Official
Phone
(845) 490-6060

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

300 NW 1St Ave
Williston, FL 32696-2006

Mailing address

300 NW 1St Ave
Williston, FL 32696-2006

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231016001187 FL Part A Provider - Skilled Nursing Facility 9234584962 Practice locations: Williston, FL

Skilled nursing facility certification: CCN 105467

Legal name
WILLISTON NURSING AND REHAB LLC
Doing business as
WILLISTON CARE CENTER AND REHAB
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 1, 1984
Last certification
Apr 3, 2025
Beds
120
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
Aug 1, 2023
Organization structure
LLCProprietary
Incorporated
Feb 11, 2022 in DE
Enrollment address
300 NW 1St Ave
Williston, FL 32696-2006
Nursing home name
WILLISTON CARE CENTER AND REHAB
Affiliated entity
FL SNF TRUST

Care Compare: Nursing home

Medicare Care Compare
Listed as
Williston Care Center and RehabCCN 105467 · All quality measures
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
May 1, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120110.7 residents per day on average
Chain
FL SNF Trust10 facilities in the chain
Penalties (3 years)
2Fines totaling $15,593

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1060398Williston Nursing and Rehab LLC300 NW 1St Avenue, Williston, FL 32696Certificate of waiverOct 22, 2026

National Provider Directory

National Provider Directory

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

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
Williston Nursing Holdco LLC Organization, Williston, FL Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Aug 1, 2023 100%
Moss M Ellenbogen Individual Corporate Officer Aug 1, 2023
Hemwattie Baijnath Individual W-2 Managing EmployeeAdministrator Aug 1, 2023
FL Master Opco Holdco II LLC Organization, North Miami Beach, FL LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Aug 1, 2023 100%
FL SNF Trust I Organization, North Miami Beach, FL 5% Or Greater Indirect Ownership Interest Aug 1, 2023 50%
FL SNF Trust II Organization, North Miami Beach, FL 5% Or Greater Indirect Ownership Interest Aug 1, 2023 50%

Facilities with the same owner 14

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

View all 14

Practitioners & affiliated clinicians

Affiliated clinicians 5

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": "1647302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647302400000",
    "number": "1811645260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 NW 1ST AVE",
            "city": "WILLISTON",
            "state": "FL",
            "postal_code": "326962006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 NW 1ST AVE",
            "city": "WILLISTON",
            "state": "FL",
            "postal_code": "326962006",
            "telephone_number": "352-528-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLISTON NURSING AND REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-15",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A",
        "authorized_official_last_name": "SCHEINER",
        "authorized_official_first_name": "MOSHE",
        "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 Williston, FL

Sources for this page

Verify at the official NPI Registry.