Fairport SNF LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FAIRPORT SNF LLC

Practice address

4646 Fairport Nine Mile PT Rd
Fairport, NY 14450-1163

Phone

(585) 377-0350

Fax

(585) 377-2620

NPI assigned

Jun 5, 2024

Organization subpart

No

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

Authorized official

Name

Eliezer Zelman

Title

Authorized Member

Phone

(845) 490-6060

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Skilled nursing facility certification: CCN 335576

Legal name

FAIRPORT SNF LLC

Doing business as

FAIRPORT SKILLED NURSING & REHAB

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 1, 1977

Last certification

May 13, 2025

Beds

196

Ownership / control type

Limited Liability Corporation

Most recent change of ownership

May 17, 2024

Organization structure

LLCProprietary

Enrollment address

4646 Fairport Nine Mile PT Rd
Fairport, NY 14450-1163

Nursing home name

FAIRPORT REHABILITATION AND NURSING CENTER

Listed as

Fairport Rehabilitation and Nursing CenterCCN 335576 · All quality measures

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

2 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jan 1, 1977

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

196138.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

All disclosed owners & managing parties 15

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

Owners & managing parties with NPI records 1

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

• Yehuda L Nussbaum, D.O

  • Family Medicine Physician
  • Rochester, NY
  • NPI 1871724351

  Adp of the SNF

  CMS ownership

Practitioners 1

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

• Yehuda L Nussbaum, D.O

  • Family Medicine Physician
  • Rochester, NY
  • NPI 1871724351
  NPD (past)

Affiliated clinicians 1

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

• Yehuda L Nussbaum, D.O

  • Family Medicine Physician
  • Rochester, NY
  • NPI 1871724351

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1717545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1881435576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4646 FAIRPORT NINE MILE PT RD",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144501163",
            "telephone_number": "585-377-0350",
            "fax_number": "585-377-2620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 FAIRPORT NINE MILE PT RD",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144501163",
            "telephone_number": "585-377-0350",
            "fax_number": "585-377-2620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRPORT SNF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-05",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "ZELMAN",
        "authorized_official_first_name": "ELIEZER",
        "authorized_official_title_or_position": "AUTHORIZED MEMBER",
        "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": []
}

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• Jin Fang, ACUPUNCTURIST
• Sarah Kidd Farney, PSY.D.
• Shannon Lynn Favalo, PT
• Gia M. Fedrau, RN

• Skilled Nursing Facility in Fairport, NY
• Providers in Fairport, NY by specialty
• Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; 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.