NPIMap

Organization Active NPI

Sunbridge Beckley Health Care LLC

Doing business as Pine Lodge Center

  • Skilled Nursing Facility
  • Beckley, WV
National Provider Identifier
1841247376
Registry record updated Jul 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
18 Issued in WV
Legal business name
SUNBRIDGE BECKLEY HEALTH CARE LLC
Doing business as
Pine Lodge Center
Practice address
405 Stanaford Rd
Beckley, WV 25801-3143
Phone
(304) 252-6317
Fax
(304) 253-4140
NPI assigned
May 30, 2006
Last updated
Jul 13, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
SUNBRIDGE HEALTHCARE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 13, 2015

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

Authorized official

Name
Michael Berg
Title
Assistant Secretary
Phone
(505) 821-3355

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 18 WV
Skilled Nursing Facility 314000000X 18 WV Primary

Addresses

Primary practice location

405 Stanaford Rd
Beckley, WV 25801-3143

Mailing address

101 Sun Ave NE
Compliance Department
Albuquerque, NM 87109-4373
Phone (505) 468-5604

Other identifiers 1

IdentifierTypeStateIssuer
0004048000MedicaidWV

Other names 1

  • Pine Lodge Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090409000693 WV Part A Provider - Skilled Nursing Facility 2567519440 Practice locations: Beckley, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841247376. Details of each certification follow.

Skilled nursing facility certification: CCN 515001

Legal name
SUNBRIDGE BECKLEY HEALTH CARE LLC
Doing business as
PINE LODGE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1967
Last certification
Nov 15, 2023
Beds
120
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Genesis Healthcare
Organization structure
LLCProprietary
Incorporated
May 10, 1982 in WV
Enrollment address
405 Stanaford Rd
Pine Lodge
Beckley, WV 25801-3143
Nursing home name
PINE LODGE
Affiliated entity
GENESIS HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pine LodgeCCN 515001 · All quality measures
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 1, 1967
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120115.9 residents per day on average
Chain
Genesis Healthcare184 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
1Fines totaling $20,910

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
51D0235296Genesis Pine Lodge405 Stanaford Rd, Beckley, WV 25801Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Part of
Sunrise HLTH Care Corp

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 23

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

NameRoleSinceShare
Mustafa Rahim Individual Operational/Managerial Control Apr 1, 2024
Adp of the SNF Apr 1, 2024
HCCF Management Group XI LLC Organization, Atlanta, GA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 10.8%
Gen Operations I LLC Organization, Kennett Square, PA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 100%
Organization, Hunt Valley, MD For-profit Adp of the SNF Jan 1, 2021
Gen Operations II LLC Organization, Kennett Square, PA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 100%
Organization, Kennett Square, PA LLC, For-profit Adp of the SNF Mar 15, 2025
FC Gen Operations Investment LLC Organization, Kennett Square, PA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 100%
Diane Louise Morris Individual Operational/Managerial Control Jan 1, 2022
Organization, Kennett Square, PA LLC, For-profit Adp of the SNF Mar 15, 2025
Sundance Rehabilitation Holdco Inc Organization, Kennett Square, PA Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 2, 2015 5.2%
Genesis Healthcare LLC Organization, Kennett Square, PA LLC, For-profit, Chain home office, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 100%
Sun Healthcare Group Inc Organization, Kennett Square, PA Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 2, 2015 65.3%
Sunbridge Care Enterprises LLC Organization, Kennett Square, PA LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Feb 2, 2015 100%
Regency Health Services, LLC Organization, Kennett Square, PA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 2, 2015 100%
Welltower Op, LLC Organization, Toledo, OH LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 1, 2023 5.7%
Arnold M Whitman Individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 10.8%
Genesis Healthcare Inc Organization, Kennett Square, PA Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 2, 2015 100%
Zac Properties XI LLC Organization, Philadelphia, PA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 7.6%
Steven E Fishman Individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 7.6%
Michael T Berg Individual Corporate OfficerSecretary Dec 1, 2012
Shelda Dawn Cox Individual Operational/Managerial Control Jul 22, 2024
Adp of the SNF Jul 22, 2024
Sunbridge Healthcare LLC Organization, Kennett Square, PA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 2, 2015 100%
Genesis Holdings LLC Organization, Kennett Square, PA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 2, 2015 100%

Owners & managing parties with NPI records 10

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 174

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

  • 1 Sutphin Drive Operations LLC

    dba Marmet Center

    • Skilled Nursing Facility
    • Marmet, WV
    • NPI 1538343710

    Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properties XI LL

    CMS ownership
  • 1000 Lincoln Drive Operations LLC

    dba Valley Center

    • Skilled Nursing Facility
    • South Charleston, WV
    • NPI 1558545749

    Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properties XI LL

    CMS ownership
  • 101 13TH Street Operations LLC

    dba Heritage Center

    • Skilled Nursing Facility
    • Huntington, WV
    • NPI 1912181223

    Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properties XI LL

    CMS ownership
  • 106 Tyree Street Operations LLC

    dba Ansted Center

    • Skilled Nursing Facility
    • Ansted, WV
    • NPI 1639353816

    Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properties XI LL

    CMS ownership
  • 1539 Country Club Road Operations LLC

    dba Tygart Center at Fairmount Campus

    • Skilled Nursing Facility
    • Fairmont, WV
    • NPI 1578709341

    Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properties XI LL

    CMS ownership
  • 1543 Country Club Road Manor Operations LLC

    dba Pierpont Center at Fairmont Campus

    • Skilled Nursing Facility
    • Fairmont, WV
    • NPI 1396981064

    Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Welltower Op, LLC, Zac Properties XI LLC

    CMS ownership
  • 161 Bakers Ridge Road Operations LLC

    dba Madison Center

    • Skilled Nursing Facility
    • Morgantown, WV
    • NPI 1073797387

    Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properties XI LL

    CMS ownership
  • 1631 Ritter Drive Operations LLC

    dba Raleigh Center

    • Skilled Nursing Facility
    • Daniels, WV
    • NPI 1063696243

    Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation Holdco Inc, Zac Properties XI LLC

    CMS ownership
  • 200 South Ritchie Avenue Operations LLC

    dba Ravenswood Village

    • Skilled Nursing Facility
    • Ravenswood, WV
    • NPI 1124202304

    Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properties XI LL

    CMS ownership
  • 201 Wood Street Operations LLC

    dba Sistersville Center

    • Skilled Nursing Facility
    • Sistersville, WV
    • NPI 1831373026

    Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properties XI LL

    CMS ownership
  • 2720 Charles Town Road Operations LLC

    dba Care Haven Center

    • Skilled Nursing Facility
    • Martinsburg, WV
    • NPI 1053595355

    FC Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation Holdco Inc, Wellt

    CMS ownership
  • 302 Cedar Ridge Road Operations LLC

    dba Cedar Ridge Center

    • Skilled Nursing Facility
    • Sissonville, WV
    • NPI 1689858987

    Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sun Healthcare Group Inc, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properties XI LL

    CMS ownership
View all 174

Practitioners & affiliated clinicians

Practitioners 3

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.

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": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436745600000",
    "number": "1841247376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SUN AVE NE",
            "address_2": "COMPLIANCE DEPARTMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094373",
            "telephone_number": "505-468-5604",
            "fax_number": "505-468-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 STANAFORD RD",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258013143",
            "telephone_number": "304-252-6317",
            "fax_number": "304-253-4140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNBRIDGE BECKLEY HEALTH CARE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNBRIDGE HEALTHCARE LLC",
        "enumeration_date": "2006-05-30",
        "last_updated": "2015-07-13",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-821-3355"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "WV",
            "license": "18",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WV",
            "license": "18",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0004048000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Lodge Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beckley, WV

Sources for this page

Verify at the official NPI Registry.