NPIMap

Organization Active NPI

The Bay at Dyersburg Health and Rehabilitation Center LLC

Doing business as Dyersburg Health and Rehabilitation Center

  • Skilled Nursing Facility
  • Dyersburg, TN
National Provider Identifier
1942954060
Registry record updated Sep 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
THE BAY AT DYERSBURG HEALTH AND REHABILITATION CENTER LLC
Doing business as
Dyersburg Health and Rehabilitation Center
Practice address
350 E Tickle St
Dyersburg, TN 38024-3118
Phone
(731) 285-9710
Fax
(731) 285-9949
NPI assigned
Feb 8, 2022
Last updated
Sep 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2023

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

Authorized official

Name
Menachem Ruvel
Title
Managing Member
Phone
(516) 605-9800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

350 E Tickle St
Dyersburg, TN 38024-3118

Mailing address

350 E Tickle St
Dyersburg, TN 38024-3118
Phone (731) 285-9710

Other names 1

  • Dyersburg Health and Rehabilitation Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220719003673 TN Part A Provider - Skilled Nursing Facility 7618358813 Practice locations: Dyersburg, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942954060. Details of each certification follow.

Skilled nursing facility certification: CCN 445497

Legal name
THE BAY AT DYERSBURG HEALTH AND REHABILITATION CENTER LLC
Doing business as
DYERSBURG HEALTH AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 20, 2009
Last certification
Jun 30, 2021
Beds
123
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Champion Care, LLC
Organization structure
LLCProprietary
Incorporated
Jan 14, 2022 in TN
Enrollment address
350 E Tickle St
Dyersburg, TN 38024-3118
Nursing home name
DYERSBURG HEALTH AND REHABILITATION CENTER
Affiliated entity
CHAMPION CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Dyersburg Health and Rehabilitation CenterCCN 445497 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Nov 20, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12369.3 residents per day on average
Chain
Champion Care22 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
44D0897283Dyersburg Health and Rehabilitation Center350 East Tickle Street, Dyersburg, TN 38024Certificate of waiverJan 31, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Andrew I Garbacz Individual OtherTrustee of Legacy SNF Opco Holdi Jun 1, 2022
Benjamin Todd McGovern Individual W-2 Managing EmployeeAdministrator Jan 23, 2023 100%
The Bay at Highlands Holdco LLC Organization, Rockville Centre, NY Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Jun 1, 2022 100%
TN2 Opco Holdings LLC Organization, Woodmere, NY Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 1, 2022 25%
BL Capital Group Holdings LLC Organization, Mineola, NY Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 1, 2022 10%
Champion Care LLC Organization, Rockville Centre, NY LLC, Management services company, For-profit Operational/Managerial Control Jun 1, 2022
Menachem Ruvel Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2022 37.5%
Corporate OfficerManager Jun 1, 2022
Operational/Managerial ControlManaging Member of the Bay at Dy Jun 1, 2022
Legacy SNF Opco Holdings Trust Organization, Cedarhurst, NY Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 1, 2022 12.5%
Yisroel N Weinberg Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2022 37.5%
Corporate OfficerManager Jun 1, 2022
Operational/Managerial ControlManaging Member of the Bay at Dy Jun 1, 2022
Benjamin Landa Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2022 10%
Legacy SNF Opco Holdings LLC Organization, Cedarhurst, NY Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 1, 2022 12.5%

Facilities with the same owner 15

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

View all 15

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 3

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": "1644278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694131200000",
    "number": "1942954060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 E TICKLE ST",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380243118",
            "telephone_number": "731-285-9710",
            "fax_number": "731-285-9949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 E TICKLE ST",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380243118",
            "telephone_number": "731-285-9710",
            "fax_number": "731-285-9949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BAY AT DYERSBURG HEALTH AND REHABILITATION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-08",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A",
        "authorized_official_last_name": "RUVEL",
        "authorized_official_first_name": "MENACHEM",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "516-605-9800"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dyersburg Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dyersburg, TN

Sources for this page

Verify at the official NPI Registry.