Shoal Creek Rehabilitation Center
500 Hospital Drive, Crestview, FL 32539


Shoal Creek Rehabilitation Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 106028. The address is 500 Hospital Drive, Crestview, FL 32539. The zip code is 32539. The phone number is 8506893146.


Shoal Creek Rehabilitation Center · 500 Hospital Drive, Crestview, FL 32539

Federal Provider Number 106028
Provider Name SHOAL CREEK REHABILITATION CENTER
Address 500 HOSPITAL DRIVE
CRESTVIEW, FL 32539
Phone Number 8506893146
SSA County Code 450
County Name Okaloosa
Ownership Type For profit - Corporation
Certified Beds 120
Certified Beds Residents 103
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name 500 SOUTH HOSPITAL DRIVE OPERATIONS LLC
Date First Approved to Provide Medicare Medicaid Services 04/27/2000
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 Both
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 5
Health Inspection Rating 4
Quality Measure Rating 5
Staffing Rating 3
RN Staffing Rating 2
Reported CNA Staffing Hours per Resident per Day 3.16262
Reported LPN Staffing Hours per Resident per Day 1.2199
Reported RN Staffing Hours per Resident per Day 0.47427
Reported Licensed Staffing Hours per Resident per Day 1.69417
Reported Total Nurse Staffing Hours per Resident per Day 4.85679
Reported Physical Therapist Staffing Hours per Resident Per Day 0.05291
Expected CNA Staffing Hours per Resident per Day 2.29542
Expected LPN Staffing Hours per Resident per Day 0.62478
Expected RN Staffing Hours per Resident per Day 1.09085
Expected Total Nurse Staffing Hours per Resident per Day 4.01106
Adjusted CNA Staffing Hours per Resident per Day 3.38069
Adjusted LPN Staffing Hours per Resident per Day 1.62059
Adjusted RN Staffing Hours per Resident per Day 0.32486
Adjusted Total Nurse Staffing Hours per Resident per Day 4.88081
Cycle 1 Total Number of Health Deficiencies 2
Cycle 1 Number of Standard Health Deficiencies 2
Cycle 1 Health Deficiency Score 8
Cycle 1 Standard Survey Health Date 04/27/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 8
Cycle 2 Total Number of Health Deficiencies 5
Cycle 2 Number of Standard Health Deficiencies 2
Cycle 2 Number of Complaint Health Deficiencies 3
Cycle 2 Health Deficiency Score 24
Cycle 2 Standard Health Survey Date 07/08/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 24
Cycle 3 Total Number of Health Deficiencies 3
Cycle 3 Number of Standard Health Deficiencies 3
Cycle 3 Health Deficiency Score 12
Cycle 3 Standard Health Survey Date 08/13/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 12
Total Weighted Health Survey Score 14
Number of Substantiated Complaints 2
Number of Fines 1
Total Amount of Fines in Dollars $5850.00
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Shoal Creek Rehabilitation Center

Owner Name Role Association Date
ALG LAVIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
BRYSON, CHRISTOPHER (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/01/2015
CMC II INVESTORS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/01/2012
CMC II LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 03/01/2012
COLUMBIA PACIFIC OPPORTUNITY FUND (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
CONTE, JOSEPH (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/01/2012
DIAS, DANIEL (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/01/2015
EPSILON HEALTH CARE PROPERTIES LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 02/01/2012
FC INVESTORS XXI, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
FC LV HOLDCO LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/01/2012
FLORIDA HEALTH CARE PROPERTIES LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
GENOA HEALTHCARE GROUP LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
HARTMAN, ROBERT (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
LAVIE CARE CENTERS, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
LOW, ASHER (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
LV INVESTMENT, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
LV OPERATIONS I, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
LV OPERATIONS II, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
MCP LAVIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
MEHAFFEY, TODD (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/14/2016
NEUBERGER, ISAAC (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
PAUL, HUBERT (Individual) MANAGING EMPLOYEE since 11/28/2016
PAUL, HUBERT (Individual) OFFICER since 11/28/2016
RAGLAND, RUSSELL (Individual) OPERATIONAL/MANAGERIAL CONTROL since 07/01/2014
SAY LA VIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
SENIOR CARE LAVIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
THE 1995 DAVID REIS FAMILY TRUST (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
USSERY, KENNETH (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/01/2015

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