Georgian Gardens Healthcare LLC
Organization Active NPI Skilled Nursing Facility · Potosi, MO
NPI 1972265452 · NPPES record last updated Oct 12, 2021
Key facts
- NPI
- 1972265452
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- GEORGIAN GARDENS HEALTHCARE LLC
- Practice address
- 1 Georgian Gardens Dr
Potosi, MO 63664-1436 - Phone
- (573) 438-6261
- NPI assigned
- Oct 12, 2021
- Organization subpart
- No
Authorized official
- Name
- Benard David Perlow
- Title
- Authorized Official
- Phone
- (443) 928-3278
Facilities with the same owner 7
Practitioners 5
-
Steven D Ebers, MD
-
Laurence Lum, D.O.
-
Don Manarang, DO
Affiliated clinicians 3
-
Steven D Ebers, MD
Medicare Care Compare: Nursing home
- Listed as
- Gardens Health and Rehab, the
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★☆☆☆☆ 1 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Partnership
- Certified
- Nov 20, 1992
- Medicare certification status
- Active
- Certified beds
- 120 · 90.4 residents per day on average
- Penalties (3 years)
- 2 · fines totaling $8,021
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Skilled nursing facility certification: CCN 265516
- Legal name
- GEORGIAN GARDENS HEALTHCARE LLC
- Doing business as
- GEORGIAN GARDENS CENTER FOR REHAB AND HEALTHCARE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 20, 1992
- Last certification
- Mar 12, 2025
- Beds
- 120
- Ownership / control type
- Partnership
- Multi-facility organization
- PRIME HEALTHCARE
- Most recent change of ownership
- Jul 1, 2025
- Organization structure
- LLC · Proprietary
- Incorporated
- Dec 17, 2020 in MO
- Enrollment address
- 1 Georgian Gardens Dr
Potosi, MO 63664-1436
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| David Yitzchok Kleiner |
5% Or Greater Indirect Ownership Interest | Aug 31, 2021 | 10.2% |
| Dkyh Missouri LLC |
5% Or Greater Direct Ownership Interest | Aug 31, 2021 | 10.2% |
| Samuel Stern |
Corporate Officer |
Jan 1, 2023 | |
| Sloans Lake Trust |
5% Or Greater Indirect Ownership Interest | Aug 31, 2021 | 63.33% |
| Blue Sky Basin LLC |
5% Or Greater Direct Ownership Interest | Aug 31, 2021 | 66.66% |
| Suzanne Mayfield |
W-2 Managing Employee |
Aug 31, 2021 | |
| Bernard David Perlow |
5% Or Greater Indirect Ownership Interest | Aug 31, 2021 | 23.1% |
| Corporate Director |
Aug 31, 2021 | ||
| Eliot Berger |
Corporate Director |
Aug 31, 2021 | |
| Other |
Aug 31, 2021 | ||
| DKDP Missouri LLC |
5% Or Greater Direct Ownership Interest | Aug 31, 2021 | 23.1% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20211004000376 | MO | Part a Provider - Skilled Nursing Facility | 9830597004 | Practice locations: Potosi, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
1 Georgian Gardens Dr
Potosi, MO 63664-1436
Mailing address
110 Rockaway Tpke Ste 6
Lawrence, NY 11559-1626
Other names
- Georgian Gardens Center for Rehab and Healthcare
Other providers in Potosi, MO
- Samantha Alanna Finley
- Tracy M Fite
- Melinda Kaye Fox
- Tammy A Franek
- Genoa Healthcare LLC
- Georgian Gardens Opco, LLC
- Georgian Gardens Operations Management LLC
- Jennifer Gillam
- Allie Reshea Golden
- Gordon Goldman MD LLC
All providers in Potosi, MO · Skilled Nursing Facility in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2021. 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.