NPIMap

Organization Active NPI

Port Charlotte Opco, LLC

Doing business as Port Charlotte Center for Nursing & Rehabilitation

  • Skilled Nursing Facility
  • Port Charlotte, FL
National Provider Identifier
1902558398
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PORT CHARLOTTE OPCO, LLC
Doing business as
Port Charlotte Center for Nursing & Rehabilitation
Sun Harbor Healthcare
Practice address
18480 Cochran Blvd
Port Charlotte, FL 33948-3379
Phone
(941) 743-4700
Fax
(941) 743-2358
NPI assigned
Jan 26, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

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

Authorized official

Name
Mathew Varghese
Title
Member
Phone
(917) 817-3530

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

18480 Cochran Blvd
Port Charlotte, FL 33948-3379

Mailing address

18480 Cochran Blvd
Port Charlotte, FL 33948-3379
Phone (941) 743-4700

Other identifiers 1

IdentifierTypeStateIssuer
130470983OtherFLLICENSE

Other names 2

  • Port Charlotte Center for Nursing & Rehabilitation Doing business as
  • Sun Harbor Healthcare Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL PortCharlotte Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220825003546 FL Part A Provider - Skilled Nursing Facility 5890179782 Practice locations: Port Charlotte, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902558398. Details of each certification follow.

Skilled nursing facility certification: CCN 105982

Legal name
PORT CHARLOTTE OPCO, LLC
Doing business as
SUN HARBOR HEALTHCARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 12, 1998
Last certification
Sep 19, 2024
Beds
120
Ownership / control type
Individual
Multi-facility organization
Excelsior
Most recent change of ownership
May 3, 2022
Organization structure
LLCProprietary
Incorporated
Dec 27, 2021 in DE
Enrollment address
18480 Cochran Blvd
Port Charlotte, FL 33948-3379
Nursing home name
SUN HARBOR HEALTHCARE
Affiliated entity
EXCELSIOR CARE GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Sun Harbor HealthcareCCN 105982 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
Mar 12, 1998
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120117.5 residents per day on average
Chain
Excelsior Care Group33 facilities in the chain

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
10D0939044Sun Harbor Healthcare18480 Cochran Blvd, Port Charlotte, FL 33948Certificate of waiverJan 19, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Woodie Wallace Lee Individual W-2 Managing EmployeeAdministrator May 1, 2022 100%
Cheskel David Berkowitz Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 14.28%
Joseph Orgel Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 14.28%
Port Charlotte Member LLC Organization, Port Charlotte, FL Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Apr 1, 2022 100%
David a Butler Individual Contracted Managing EmployeeMD; Jan 1, 2024 100%
Apwa Member LLC Organization, Oakland Gardens, NY Created for acquisition, LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024
ZBL FL Empire Opco LLC Organization, Brooklyn, NY Created for acquisition, LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 2, 2024
BS Member LLC Organization, Brooklyn, NY Created for acquisition, LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024
Marton Ornstein Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 14.28%
SH Indigo Citadel Investors LLC Organization, Brooklyn, NY Created for acquisition, LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 28.62%
Joel Zupnick Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 14.28%
Joel Leifer Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 14.28%
Corporate OfficerBusiness Manager Jan 1, 2024 100%
Flnho Capital Group LLC Organization, Lawrence, NY Created for acquisition, LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024
GG Flwa LLC Organization, Brooklyn, NY Created for acquisition, LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024

Owners & managing parties with NPI records 1

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

Facilities with the same owner 31

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

View all 31

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1643155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718323200000",
    "number": "1902558398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18480 COCHRAN BLVD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339483379",
            "telephone_number": "941-743-4700",
            "fax_number": "941-743-2358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18480 COCHRAN BLVD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339483379",
            "telephone_number": "941-743-4700",
            "fax_number": "941-743-2358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT CHARLOTTE OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-26",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A",
        "authorized_official_last_name": "VARGHESE",
        "authorized_official_first_name": "MATHEW",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "917-817-3530"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "130470983",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "PortCharlotte",
            "affiliation": "N",
            "endpointDescription": "Port Charlotte OpCo, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "18480 Cochran Blvd",
            "city": "Port Charlotte",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339483379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Port Charlotte Center for Nursing & Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sun Harbor Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.