810 Opco LLC
Organization Active NPI Skilled Nursing Facility · Independence, MO
NPI 1841901899 · NPPES record last updated Dec 12, 2022
Key facts
- NPI
- 1841901899
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- 810 OPCO LLC
- Practice address
- 810 E Walnut St
Independence, MO 64050-4025 - Phone
- (816) 461-9600
- NPI assigned
- Dec 12, 2022
- Organization subpart
- No
Authorized official
- Name
- David Garetz
- Title
- Cfo
- Phone
- (213) 395-1848
Owners & managing parties with NPI records 1
-
Srinath Tadakamalla, M.D
Practitioners 1
-
Srinath Tadakamalla, M.D
Affiliated clinicians 1
-
Srinath Tadakamalla, M.D
Medicare Care Compare: Nursing home
- Listed as
- Carmel Hills Wellness & Rehabilitation
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jan 4, 2002
- Medicare certification status
- Active
- Certified beds
- 194 · 156.8 residents per day on average
- Chain
- Opco Skilled Management
- Penalties (3 years)
- 1 · fines totaling $20,787
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0992264 | Carmel Hills Wellness & Rehabilitation | Certificate of waiver | Oct 10, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Skilled nursing facility certification: CCN 265727
- Legal name
- 810 OPCO LLC
- Doing business as
- CARMEL HILLS WELLNESS AND REHABILITATION
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 4, 2002
- Last certification
- Nov 25, 2024
- Beds
- 194
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- OPCO
- Most recent change of ownership
- Dec 12, 2022
- Organization structure
- LLC · Proprietary
- Enrollment address
- 810 E Walnut St
Independence, MO 64050-4025 - Nursing home name
- CARMEL HILLS WELLNESS & REHABILITATION
- Affiliated entity
- OPCO SKILLED MANAGEMENT
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Esdov Investments LLC |
Adp of the SNF | Dec 12, 2022 | |
| Charmaine Denise Coffman-Williams |
Adp of the SNF | Dec 12, 2022 | |
| First Sweetzer Holdings LLC |
Adp of the SNF | Dec 12, 2022 | |
| Indirect Ownership Interest | Dec 12, 2022 | 2% | |
| 810 E Walnut Street Mo LLC |
5% Or Greater Mortgage Interest | Dec 12, 2022 | 100% |
| Adp of the SNF | Dec 12, 2022 | ||
| Sasem Investments LLC |
Indirect Ownership Interest | Dec 12, 2022 | 2.58% |
| El Dorado Nursing and Rehabilitation LLC |
Direct Ownership Interest | Dec 12, 2022 | 100% |
| Ozark Healthcare Realty LLC |
5% Or Greater Mortgage Interest | Dec 12, 2022 | 100% |
| Adp of the SNF | Dec 12, 2022 | ||
| Montgomery Sky Trust |
5% Or Greater Mortgage Interest | Dec 12, 2022 | 99% |
| Adp of the SNF | Dec 12, 2022 | ||
| Emerald Property Partners LLC |
5% Or Greater Mortgage Interest | Dec 12, 2022 | 74.5% |
| Adp of the SNF | Dec 12, 2022 | ||
| Rimpau Holdings Trust |
Indirect Ownership Interest | Dec 12, 2022 | 34.1% |
| Crestview Trust |
Indirect Ownership Interest | Dec 12, 2022 | 63.33% |
| Caliber Advisors LLC |
Indirect Ownership Interest | Dec 12, 2022 | 97% |
| Jubilee Master Holdings LLC |
Adp of the SNF | Dec 12, 2022 | |
| Hatteras Investments LLC |
Adp of the SNF | Dec 12, 2022 | |
| Indirect Ownership Interest | Dec 12, 2022 | 1% | |
| Gibraltar Trust |
5% Or Greater Mortgage Interest | Dec 12, 2022 | 20% |
| Adp of the SNF | Dec 12, 2022 | ||
| David Garetz |
Operational/Managerial Control | Dec 12, 2022 | |
| Srinath Tadakamalla |
Adp of the SNF | Dec 12, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230126002276 | MO | Part a Provider - Skilled Nursing Facility | 0345611554 | Practice locations: Independence, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
810 E Walnut St
Independence, MO 64050-4025
Mailing address
4525 Wilshire Blvd Ste 210
Los Angeles, CA 90010-3846
Other names
- Carmel Hills Wellness & Rehabilitation
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.