NPIMap

Organization Active NPI

Stonegate Healthcare LLC

  • Skilled Nursing Facility
  • Crossett, AR
National Provider Identifier
1942939426
Registry record updated Jun 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
STONEGATE HEALTHCARE LLC
Practice address
118 Jerry Selby Dr
Crossett, AR 71635-4734
Phone
(870) 364-1534
NPI assigned
Jun 8, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2022

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

Authorized official

Name
David J
Title
Cao
Phone
(917) 410-5283

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

118 Jerry Selby Dr
Crossett, AR 71635-4734

Mailing address

150 Oberlin Ave N Ste 6
Lakewood, NJ 08701-4535
Phone (732) 800-6005

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230311000331 AR Part A Provider - Skilled Nursing Facility 8820461916 Practice locations: Crossett, AR

Skilled nursing facility certification: CCN 045437

Legal name
STONEGATE HEALTHCARE LLC
Doing business as
NIGHTINGALE AT STONEGATE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 7, 2010
Last certification
Apr 12, 2024
Beds
76
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Independence Healthcare Management
Organization structure
LLCProprietary
Incorporated
Aug 12, 2001 in AR
Enrollment address
118 Jerry Selby Drive
Crossett, AR 71635-4734
Nursing home name
NIGHTINGALE AT STONEGATE
Affiliated entity
NIGHTINGALE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Nightingale at StonegateCCN 045437
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Dec 7, 2010
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7658.6 residents per day on average
Chain
Nightingale5 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
04D2013591Nightingale at Stonegate118 Jerry Selby Drive, Crossett, AR 71635Certificate of waiverSep 21, 2026

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
Sri Family Irrevocable Trust Organization, Brooklyn, NY Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 1, 2022 11%
Adp of the SNF Mar 31, 2022
Independence Arkansas HCM LLC Organization, Brooklyn, NY LLC, Management services company, Holding company Operational/Managerial Control Aug 1, 2022
Adp of the SNF Jan 16, 2026
Steven Isaac Individual 5% Or Greater Indirect Ownership InterestMember Aug 31, 2022 11%
Adp of the SNF Aug 31, 2022
Lisa M Hensley Individual Operational/Managerial Control Aug 31, 2022
Adp of the SNF Aug 31, 2022
Stonegate Realty Holdings LLC Organization, Lakewood, NJ LLC, Holding company Adp of the SNF Aug 1, 2022
Dov B Braun Individual 5% Or Greater Indirect Ownership Interest Aug 31, 2022 22.5%
Ardj LLC Organization, Brooklyn, NY LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 1, 2022 33%
Adp of the SNF Mar 31, 2022
Cutlass Op Family Trust II Organization, Brooklyn, NY Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 31, 2022 22.5%
Cutlass Op Holdings LLC Organization, Brooklyn, NY Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 1, 2022 45%
Adp of the SNF Apr 24, 2025
Direct Ownership Interest Aug 1, 2022
David Jakobowitch Individual 5% Or Greater Indirect Ownership Interest Aug 31, 2022 33%
Adp of the SNF Aug 31, 2022
Aviva Braun Individual Indirect Ownership Interest Aug 31, 2022 22.5%
Sri Nightingale LLC Organization, Brooklyn, NY LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Mar 31, 2022 22%
Adp of the SNF Mar 31, 2022
Cutlass Op Family Trust I Organization, Brooklyn, NY Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 1, 2022 22.5%
Tim M Simon Individual Operational/Managerial Control Aug 31, 2022
Adp of the SNF Aug 1, 2022

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 7

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

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": "1654646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654646400000",
    "number": "1942939426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 OBERLIN AVE N STE 6",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087014535",
            "telephone_number": "732-800-6005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 JERRY SELBY DR",
            "city": "CROSSETT",
            "state": "AR",
            "postal_code": "716354734",
            "telephone_number": "870-364-1534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONEGATE HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-08",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A",
        "authorized_official_last_name": "J",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CAO",
        "authorized_official_telephone_number": "917-410-5283"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crossett, AR

Sources for this page

Verify at the official NPI Registry.