Chipola Health and Rehabilitation Center
4294 3rd Avenue, Marianna, FL 32446


Chipola Health and Rehabilitation Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 105729. The address is 4294 3rd Avenue, Marianna, FL 32446. The zip code is 32446. The phone number is 8505263191.


Chipola Health and Rehabilitation Center · 4294 3rd Avenue, Marianna, FL 32446

Federal Provider Number 105729
Provider Name CHIPOLA HEALTH AND REHABILITATION CENTER
Address 4294 3RD AVENUE
MARIANNA, FL 32446
Phone Number 8505263191
SSA County Code 310
County Name Jackson
Ownership Type For profit - Corporation
Certified Beds 60
Certified Beds Residents 53
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name NF CHIPOLA LLC
Date First Approved to Provide Medicare Medicaid Services 05/07/1991
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 5
Health Inspection Rating 5
Quality Measure Rating 5
Staffing Rating 5
RN Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 2.83019
Reported LPN Staffing Hours per Resident per Day 0.98113
Reported RN Staffing Hours per Resident per Day 0.86321
Reported Licensed Staffing Hours per Resident per Day 1.84434
Reported Total Nurse Staffing Hours per Resident per Day 4.67453
Reported Physical Therapist Staffing Hours per Resident Per Day 0.06321
Expected CNA Staffing Hours per Resident per Day 2.44657
Expected LPN Staffing Hours per Resident per Day 0.59477
Expected RN Staffing Hours per Resident per Day 0.88027
Expected Total Nurse Staffing Hours per Resident per Day 3.92161
Adjusted CNA Staffing Hours per Resident per Day 2.83844
Adjusted LPN Staffing Hours per Resident per Day 1.36916
Adjusted RN Staffing Hours per Resident per Day 0.73272
Adjusted Total Nurse Staffing Hours per Resident per Day 4.8048
Cycle 1 Total Number of Health Deficiencies 1
Cycle 1 Number of Standard Health Deficiencies 1
Cycle 1 Health Deficiency Score 4
Cycle 1 Standard Survey Health Date 03/15/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 4
Cycle 2 Standard Health Survey Date 06/02/2016
Cycle 3 Standard Health Survey Date 06/25/2015
Total Weighted Health Survey Score 2
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Chipola Health and Rehabilitation Center

Owner Name Role Association Date
BARROW STREET REAL ESTATE FUND III, LP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/30/2010
BSREF III PARALLEL INVESTOR II LP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/30/2010
BSREF III PARALLEL INVESTOR I LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/30/2010
BSREF III PARALLEL INVESTOR III LP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/30/2010
GARNIER, AMANDA (Individual) OFFICER since 09/01/2015
GCH MANAGEMENT SERVICES LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/01/2008
GULF COAST FACILITIES LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 11/01/2008
GULF COAST HEALTH CARE HOLDINGS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/30/2010
GULF COAST HEALTH CARE LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/01/2008
HS DELTA GST TR 2 (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/30/2010
JS DELTA GST TR (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/30/2010
RICHARDSON, JAMES (Individual) OFFICER since 09/01/2015
SOUTHEAST US HOLDINGS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/30/2010
WOLF, SHERYL (Individual) OFFICER since 09/01/2015
ZURAFF, CONNIE (Individual) MANAGING EMPLOYEE since 12/15/2010

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