WOODHAVEN NURSING HOME
NPI 1568459279
Skilled Nursing Facility in Port Jefferson Station, NY

Active since September 29, 2005CLIA 33D2214670 · Waiver
1360 ROUTE 112, PORT JEFFERSON STATION, NY 11776(631) 473-7100(631) 473-7118 Get Directions Write a Review

NPPES record last updated: February 24, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Woodhaven Nursing Home NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WOODHAVEN NURSING HOME (NPI 1568459279) is a healthcare organization registered as a skilled nursing facility in Port Jefferson Station, New York and active in the NPI registry since September 2005. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Kenneth Gaul, Administrator, as its authorized official.

NPPES Registry Identity

NPI1568459279
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameJBG HOLDING COMPANY LLC
Location Address1360 ROUTE 112Port Jefferson Station, NY 11776-3078
Mailing Address1360 Route 112Port Jefferson Station, NY 11776-3078 · (631) 473-7100 · Fax (631) 473-7118
Fax(631) 473-7118
Organization SubpartNo
Authorized OfficialKenneth GaulAdministrator · (631) 473-7100
Enumeration DateSeptember 29, 2005
Last NPPES UpdateFebruary 24, 2012
NPI 1568459279 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in NY · 5151316N
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
1360 ROUTE 112, Port Jefferson Station, NY 11776

Other Names 1

Doing Business AsWoodhaven Nursing Home

Other Identifiers 4

Medicare ID-Type Unspecified335514001NY · Medicare
Medicare NSC4053760001NY
Other5151316NNY · Ny Operating Certificate
Medicaid00308470NY

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D2214670

Woodhaven Nursing Home · Port Jefferson Station, NY
Active · expires Mar 26, 2027
CLIA Number33D2214670
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateFebruary 24, 2021
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Ion Oltean
Laboratory Phone(631) 473-7100
Laboratory LocationWoodhaven Nursing Home1360 Route 112, Port Jefferson Station, NY 11776
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physical Therapist
1360 ROUTE 112
PORT JEFFERSON STATION, NY 11776
Occupational Therapist
1360 ROUTE 112
PORT JEFFERSON STATION, NY 11776
Nurse Practitioner (Adult Health)
1360 ROUTE 112
PORT JEFFERSON STATION, NY 11776
Skilled Nursing Facility
1360 ROUTE 112
PORT JEFFERSON STATION, NY 11776
Speech-Language Pathologist
1360 ROUTE 112
PORT JEFFERSON STATION, NY 11776

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jbg Holding Company LLC's NPI number?

The NPI number for Jbg Holding Company LLC is 1568459279. It was assigned to this organization in the NPPES registry on September 29, 2005. The provider is doing business as Woodhaven Nursing Home.

Where is Jbg Holding Company LLC located?

Jbg Holding Company LLC is located at 1360 Route 112, Port Jefferson Station, NY 11776. The listed phone number is (631) 473-7100.

What is Jbg Holding Company LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Jbg Holding Company LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D2214670) is associated with this NPI, valid through March 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Jbg Holding Company LLC was last updated on February 24, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.