NPIMap

Organization Active NPI

Jefferson City Nursing and Rehabilitation Center, LLC

  • Skilled Nursing Facility
  • Jefferson City, MO
National Provider Identifier
1952476343
Registry record updated Dec 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
033026 Issued in MO
Legal business name
JEFFERSON CITY NURSING AND REHABILITATION CENTER, LLC
Practice address
1221 Southgate LN
Jefferson City, MO 65109-2465
Phone
(573) 635-3131
Fax
(573) 635-4226
NPI assigned
Nov 21, 2006
Last updated
Dec 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2023

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

Authorized official

Name
Mr. Norbert A Bennett
Title
Co-Chief Executive Officer
Phone
(716) 662-4955

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 033026 MO Primary

Addresses

Primary practice location

1221 Southgate LN
Jefferson City, MO 65109-2465

Mailing address

PO Box 428
Orchard Park, NY 14127-0428
Phone (716) 662-4955

Other identifiers 1

IdentifierTypeStateIssuer
101764306MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL ENDPOINT Other The White Stone Group d/b/a Vyne Medical

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050201000152 MO Part A Provider - Skilled Nursing Facility 9335199900 Practice locations: Jefferson City, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952476343. Details of each certification follow.

Skilled nursing facility certification: CCN 265530

Legal name
JEFFERSON CITY NURSING AND REHABILITATION CENTER LLC
Doing business as
JEFFERSON CITY NURSING AND REHABILITATION CENTER LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 9, 1993
Last certification
Dec 19, 2024
Beds
120
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
Jan 1, 2005
Organization structure
LLCProprietary
Incorporated
Oct 4, 2004 in MO
Enrollment address
1221 Southgate LN
Box 104118
Jefferson City, MO 65109-2465
Nursing home name
CAPITOL RIVER WELLNESS & REHABILITATION
Affiliated entity
NORBERT BENNETT & DONALD DENZ

Care Compare: Nursing home

Medicare Care Compare
Listed as
Capitol River Wellness & RehabilitationCCN 265530 · All quality measures
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 9, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12073.9 residents per day on average
Chain
Norbert Bennett & Donald Denz2 facilities in the chain
Penalties (3 years)
1Fines totaling $14,446

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
26D0991438Jefferson City Nursing & Rehabilitation1221 Southgate Lane, Jefferson City, MO 65109Certificate of waiverSep 19, 2027

National Provider Directory

National Provider Directory

Locations

1221 Southgate Ln
#104118
Jefferson City, MO 65109
Phone (573) 635-3131

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Donald T Denz Irrv TR Organization, Buffalo, NY 5% Or Greater Indirect Ownership Interest May 23, 2008 6%
Norbert a Bennett Individual 5% Or Greater Indirect Ownership Interest Oct 4, 2004 32.45%
Donald T Denz Individual 5% Or Greater Indirect Ownership Interest Oct 4, 2004 44%
Norbert a Bennett Irrv TR Fbo Grandchildren Organization, Holland, NY 5% Or Greater Indirect Ownership Interest May 23, 2008 5.85%
Norbert a Bennett Irrv TR Fbo Children Organization, Holland, NY 5% Or Greater Indirect Ownership Interest May 23, 2008 11.7%
D&N, LLC Organization, Orchard Park, NY LLC 5% Or Greater Direct Ownership Interest Dec 31, 2004 50%
DTD HC LLC Organization, Orchard Park, NY LLC 5% Or Greater Direct Ownership Interest Dec 31, 2004 50%
Victoria Gilbert Individual W-2 Managing EmployeeExecutive Director Jan 2, 2023 100%

Facilities with the same owner 30

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

View all 30

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 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": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701993600000",
    "number": "1952476343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 428",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "141270428",
            "telephone_number": "716-662-4955",
            "fax_number": "716-667-9230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 SOUTHGATE LN",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651092465",
            "telephone_number": "573-635-3131",
            "fax_number": "573-635-4226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON CITY NURSING AND REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "NORBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CO-CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "716-662-4955",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "033026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101764306",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "ENDPOINT",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.17.8788.1",
            "affiliationName": "The White Stone Group d/b/a Vyne Medical",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 Ashford Ctr N Ste 300",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303384863",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jefferson City, MO

Sources for this page

Verify at the official NPI Registry.