Crystal Spring Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CRYSTAL SPRING CENTER LLC

Practice address

395 Lakeside Blvd
Bayville, NJ 08721-2807

Phone

(732) 269-0500

NPI assigned

Oct 15, 2021

Organization subpart

No

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

Authorized official

Name

Sam Stern

Title

Cfo

Phone

(877) 567-0402

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Skilled nursing facility certification: CCN 315125

Legal name

CRYSTAL SPRING CENTER LLC

Doing business as

CRYSTAL LAKE HEALTHCARE AND REHABILITATION

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

May 9, 1971

Last certification

Feb 8, 2024

Beds

235

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Incorporated

Dec 21, 2020 in NJ

Enrollment address

395 Lakeside Blvd
Bayville, NJ 08721-2807

Nursing home name

CRYSTAL LAKE HEALTHCARE AND REHABILITATION

All disclosed owners & managing parties 10

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

Facilities with the same owner 1

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

• Cherry Hill Rehab and Care Center LLC

  • Skilled Nursing Facility
  • Cherry Hill, NJ
  • NPI 1578226684

  PBV Herman Holdings LLC, Poplar Opco LLC, RBNT Care LLC, SJMR, LLC, Yp Investors Group, LLC

  CMS ownership

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

• Joshua R Shua-Haim, M.D

  • Geriatric Medicine (Internal Medicine) Physician
  • Manchester, NJ
  • NPI 1073554879
  NPD (past)

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Vinod Sancheti, M.D

  • Internal Medicine Physician
  • Toms River, NJ
  • NPI 1437176088

  Nursing home

  Care Compare affiliation
• Joshua R Shua-Haim, M.D

  • Geriatric Medicine (Internal Medicine) Physician
  • Manchester, NJ
  • NPI 1073554879

  Nursing home

  Care Compare affiliation

Listed as

Crystal Lake Healthcare and RehabilitationCCN 315125

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

May 9, 1971

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

235197.0 residents per day on average

Special focus status

SFF

Penalties (3 years)

5Fines totaling $538,184

Processed by Care Compare on Aug 1, 2026.

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

{
    "created_epoch": "1634256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655856000000",
    "number": "1831852946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14C 53RD ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112322644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 LAKESIDE BLVD",
            "city": "BAYVILLE",
            "state": "NJ",
            "postal_code": "087212807",
            "telephone_number": "732-269-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL SPRING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-15",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A",
        "authorized_official_last_name": "STERN",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "877-567-0402"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Conway, BCBA
• Ramona A. Crofoot, LPC
• Kyle Cronin
• Kelly M Crosbie, LCSW
• Crystal Lake Healthcare and Rehabilitation
• Francis W Cummins, M.A.
• Danielle Dagato, OT
• Craig Danielak, SLP
• Tracy Ann Danielak, MSPT
• Matthew B Davis

• All providers in Bayville, NJ
• Skilled Nursing Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.