Five Ninety Six Sheldon Road Operations LLC
Organization Active NPI Skilled Nursing Facility · Saint Albans, VT
NPI 1891946372 · NPPES record last updated Apr 3, 2019
Key facts
- NPI
- 1891946372
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- N/A (VT)
- Legal business name
- FIVE NINETY SIX SHELDON ROAD OPERATIONS LLC
- Practice address
- 596 Sheldon Rd
Saint Albans, VT 05478-8011 - Phone
- (802) 524-6534
- Fax
- (802) 524-2429
- NPI assigned
- Oct 2, 2008
- Organization subpart
- No
Authorized official
- Name
- Michael T Berg
- Title
- VP Assistant Secretary
- Phone
- (055) 468-4742
Owners & managing parties with NPI records 1
-
Kasra Djalayer, MD
Corporate family (same tax ID) 1
Facilities with the same owner 178
Practitioners 3
-
Kasra Djalayer, MD
-
Rebecca A Souza, ANP-BC
-
Joan Andersen Twombly, NP-C
Affiliated clinicians 3
-
Kasra Djalayer, MD
-
Julie Marilyn Gomez, ARNP
-
Michael Alan Polich, N.P.
Medicare Care Compare: Nursing home
- Listed as
- Saint Albans Healthcare and Rehabilitation Center
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- May 16, 1972
- Medicare certification status
- Active
- Certified beds
- 115 · 81.2 residents per day on average
- Chain
- Genesis Healthcare
- Penalties (3 years)
- 2 · fines totaling $148,714
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 47D0685962 | Saint Albans Healthcare and Rehabilitation | Certificate of waiver | Dec 2, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
Skilled nursing facility certification: CCN 475021
- Legal name
- FIVE NINETY SIX SHELDON ROAD OPERATIONS LLC
- Doing business as
- SAINT ALBANS HEALTH AND REHABILITATION CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- May 16, 1972
- Last certification
- Jan 28, 2025
- Beds
- 115
- Ownership / control type
- Corporation
- Multi-facility organization
- Genesis Health Care
- Organization structure
- LLC · Proprietary
- Incorporated
- Jun 13, 2008 in DE
- Enrollment address
- 596 Sheldon Rd
Saint Albans, VT 05478-8011 - Nursing home name
- SAINT ALBANS HEALTHCARE AND REHABILITATION CENTER
- Affiliated entity
- GENESIS HEALTHCARE
All disclosed owners & managing parties 22
| Name | Role | Since | Share |
|---|---|---|---|
| Genesis Omg Operations LLC |
5% Or Greater Direct Ownership Interest | Sep 7, 2007 | 100% |
| Laura Bridgeford |
Corporate Officer |
Jun 1, 2024 | 100% |
| HCCF Management Group XI LLC |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 14.69% |
| Jessica Jennings |
Operational/Managerial Control | Jul 18, 2022 | |
| Adp of the SNF | Feb 3, 2025 | ||
| Gen Operations I LLC |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| |
Adp of the SNF | Feb 3, 2025 | |
| Gen Operations II LLC |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| FC-Gen Operations Investment LLC |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| Kasra Djalayer |
Operational/Managerial Control | Jun 1, 2021 | |
| Adp of the SNF | Feb 3, 2025 | ||
| Genesis Healthcare LLC |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| Sun Healthcare Group Inc |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 65.3% |
| Genesis Administrative Services LLC |
Operational/Managerial Control | Jan 1, 2019 | |
| Adp of the SNF | Feb 3, 2025 | ||
| Welltower Op, LLC |
5% Or Greater Indirect Ownership Interest | Jan 1, 2022 | 5.7% |
| Arnold M Whitman |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 10.6% |
| Genesis Healthcare Inc |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
| Zac Properties XI LLC |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 8.46% |
| Steven E Fishman |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 7.6% |
| Gregory Bogdan |
Corporate Officer |
Jun 1, 2020 | 100% |
| Avi Pinchas Mendelson |
Corporate Officer |
Apr 1, 2024 | 100% |
| Michael T Berg |
Corporate Officer |
Mar 2, 2015 | 100% |
| GHC Holdings LLC |
5% Or Greater Indirect Ownership Interest | Dec 1, 2012 | 100% |
| Genesis Holdings LLC |
5% Or Greater Indirect Ownership Interest | Feb 2, 2015 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100708000088 | VT | Part a Provider - Skilled Nursing Facility | 7618008632 | Practice locations: Saint Albans, VT |
National Provider Directory
- Tax ID family
- Five Ninety Six Sheldon Road Operations LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | N/A | VT | Yes |
Addresses
Primary practice location
596 Sheldon Rd
Saint Albans, VT 05478-8011
Mailing address
596 Sheldon Rd
Saint Albans, VT 05478-8011
Phone (802) 524-6534
Other names
- Saint Albans Healthcare & Rehabilitation Center
NPI Registry JSON
{
"created_epoch": "1222905600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1554249600000",
"number": "1891946372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "596 SHELDON RD",
"city": "SAINT ALBANS",
"state": "VT",
"postal_code": "054788011",
"telephone_number": "802-524-6534",
"fax_number": "802-524-2429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "596 SHELDON RD",
"city": "SAINT ALBANS",
"state": "VT",
"postal_code": "054788011",
"telephone_number": "802-524-6534",
"fax_number": "802-524-2429"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FIVE NINETY SIX SHELDON ROAD OPERATIONS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-10-02",
"last_updated": "2019-04-03",
"status": "A",
"authorized_official_last_name": "BERG",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "VP ASSISTANT SECRETARY",
"authorized_official_telephone_number": "055-468-4742"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "VT",
"license": "N/A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Saint Albans Healthcare & Rehabilitation Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Saint Albans Healthcare & Rehabilitation Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Saint Albans, VT
- Molly Finnigan
- Rebecca Fish
- Ashley Fitzgerald
- Catherine Fitzgerald
- Samantha Fitzgerald
- Shanley Flanagan
- Annie Flynn
- Jennifer Flynn
- Heather A Foley
- Kelly Forbes
All providers in Saint Albans, VT · Skilled Nursing Facility in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2019. 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.