NPIMap

Organization Active NPI

Heritage Villa Healthcare, LLC

  • Skilled Nursing Facility
  • Bartlesville, OK
National Provider Identifier
1831873769
Registry record updated Jun 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
HERITAGE VILLA HEALTHCARE, LLC
Practice address
1244 Woodland Loop
Bartlesville, OK 74006-5224
Phone
(918) 335-3222
NPI assigned
Jun 12, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2023

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

Authorized official

Name
Naftali Friedman
Title
Manager
Phone
(314) 631-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1244 Woodland Loop
Bartlesville, OK 74006-5224

Mailing address

477 N Lindbergh Blvd Ste 310
Saint Louis, MO 63141-7856
Phone (314) 631-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240404000555 OK Part A Provider - Skilled Nursing Facility 5496193872 Practice locations: Bartlesville, OK

Skilled nursing facility certification: CCN 375109

Legal name
HERITAGE VILLA HEALTHCARE LLC
Doing business as
HERITAGE VILLA CARE & REHAB CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1991
Last certification
Jan 14, 2025
Beds
100
Ownership / control type
Limited Liability Corporation
Multi-facility organization
MGM healthcare
Organization structure
LLCProprietary
Incorporated
Nov 23, 2022 in OK
Enrollment address
1244 Woodland Loop
Bartlesville, OK 74006-5224
Nursing home name
HERITAGE VILLA CARE & REHAB CENTER
Affiliated entity
MGM HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Heritage Villa Care & Rehab CenterCCN 375109
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Apr 1, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10087.4 residents per day on average
Chain
MGM Healthcare27 facilities in the chain
Penalties (3 years)
1Fines totaling $8,278

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
37D0674987Heritage Villa Care & Rehab Center1244 Woodland Loop, Bartlesville, OK 74006Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Allen Koss Individual Other Dec 18, 2023 50%
JFB Ok Trust Organization, Saint Louis, MO 5% Or Greater Indirect Ownership Interest Dec 18, 2023 50%
Ok SNF Holdings, LLC Organization, Saint Louis, MO LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Dec 18, 2023 50%
Naftali Friedman Individual Corporate OfficerManager Dec 18, 2023
Ok SNF Investments, LLC Organization, Saint Louis, MO LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Dec 18, 2023 50%
Southeast Ventures Trust Organization, Lakewood, NJ 5% Or Greater Indirect Ownership Interest Dec 18, 2023 48%
Peggy L Rovenstine Individual W-2 Managing EmployeeAdministrator Dec 18, 2023 100%
Yaakov Klein Individual Other Dec 18, 2023 48%

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 2

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

Affiliated clinicians 1

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": "1686528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1831873769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "477 N LINDBERGH BLVD STE 310",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417856",
            "telephone_number": "314-631-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1244 WOODLAND LOOP",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740065224",
            "telephone_number": "918-335-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE VILLA HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A",
        "authorized_official_last_name": "FRIEDMAN",
        "authorized_official_first_name": "NAFTALI",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "314-631-3000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bartlesville, OK

Sources for this page

Verify at the official NPI Registry.