93 W Main Operating LLC
Organization Active NPI Skilled Nursing Facility · Norwich, CT
NPI 1902332950 · NPPES record last updated May 11, 2017
Key facts
- NPI
- 1902332950
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- 93 W MAIN OPERATING LLC
- Practice address
- 93 W Town St
Norwich, CT 06360-2262 - Phone
- (860) 889-2614
- Fax
- (860) 822-4141
- NPI assigned
- May 11, 2017
- Organization subpart
- No
Authorized official
- Name
- Ms. Shannon Rubin
- Title
- Sole MBR
- Phone
- (860) 889-2614
Facilities with the same owner 2
Affiliated clinicians 3
-
Paul H Deutsch, MD, RPH
-
Salman Zafar, MD
Medicare Care Compare: Nursing home
- Listed as
- Norwich Sub-Acute and Nursing
- Overall star rating
- ★★★★☆ 4 of 5
- Health inspections
- ★★★★☆ 4 of 5
- Staffing
- ★★☆☆☆ 2 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jan 1, 1967
- Medicare certification status
- Active
- Certified beds
- 120 · 102.9 residents per day on average
- Penalties (3 years)
- 2 · fines totaling $47,483
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 07D0694911 | Norwich Sub-Acute Care and Nursing | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Skilled nursing facility certification: CCN 075079
- Legal name
- 93 W MAIN OPERATING LLC
- Doing business as
- NORWICH SUB-ACUTE AND NURSING
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 1967
- Last certification
- Mar 22, 2023
- Beds
- 120
- Ownership / control type
- Limited Liability Corporation
- Most recent change of ownership
- Jun 30, 2017
- Organization structure
- LLC · Proprietary
- Incorporated
- Jan 24, 2017 in CT
- Enrollment address
- 93 W Town St
Norwich, CT 06360-2262 - Nursing home name
- NORWICH SUB-ACUTE AND NURSING
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| John P Miller |
W-2 Managing Employee |
Jun 30, 2017 | |
| Eliyahu Mirlis |
Corporate Officer |
Feb 1, 2022 | |
| Nathan Rose |
Corporate Officer |
Feb 1, 2022 | |
| Operational/Managerial Control |
Feb 1, 2022 | ||
| Other |
Feb 1, 2022 | ||
| Mirlis Children Trust |
5% Or Greater Direct Ownership Interest | Feb 1, 2022 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170626001332 | CT | Part a Provider - Skilled Nursing Facility | 1153699624 | Practice locations: Norwich, CT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
93 W Town St
Norwich, CT 06360-2262
Mailing address
93 W Town St
Norwich, CT 06360-2262
Other names
- Norwich Sub-Acute and Nursing
Other providers in Norwich, CT
- A Path Forward Counseling, LLC
- Leah Marian Aakjar
- Jonathan Ryan Aanensen
- Abera H Abay
- Bethany Ackley
All providers in Norwich, CT · Skilled Nursing Facility in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2017. 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.