Northwest Florida Community Hospital (snu)
1360 Brickyard Rd, Chipley, FL 32428


Northwest Florida Community Hospital (snu) is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 106055. The address is 1360 Brickyard Rd, Chipley, FL 32428. The zip code is 32428. The phone number is 8504157400.


Northwest Florida Community Hospital (snu) · 1360 Brickyard Rd, Chipley, FL 32428

Federal Provider Number 106055
Provider Name NORTHWEST FLORIDA COMMUNITY HOSPITAL (SNU)
Address 1360 BRICKYARD RD
CHIPLEY, FL 32428
Phone Number 8504157400
SSA County Code 660
County Name Washington
Ownership Type For profit - Corporation
Certified Beds 34
Certified Beds Residents 29
Provider Type Medicare
Resides in Hospital true
Legal Business Name NORTHWEST FLORIDA HEALTHCARE, INC.
Date First Approved to Provide Medicare Medicaid Services 03/06/2003
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 5
Quality Measure Rating 2
Staffing Rating 3
RN Staffing Rating 1
Reported CNA Staffing Hours per Resident per Day 2.91379
Reported LPN Staffing Hours per Resident per Day 2.00862
Reported RN Staffing Hours per Resident per Day 0.30517
Reported Licensed Staffing Hours per Resident per Day 2.31379
Reported Total Nurse Staffing Hours per Resident per Day 5.22758
Reported Physical Therapist Staffing Hours per Resident Per Day 0.04483
Expected CNA Staffing Hours per Resident per Day 2.39235
Expected LPN Staffing Hours per Resident per Day 0.57013
Expected RN Staffing Hours per Resident per Day 0.88318
Expected Total Nurse Staffing Hours per Resident per Day 3.84566
Adjusted CNA Staffing Hours per Resident per Day 2.98851
Adjusted LPN Staffing Hours per Resident per Day 2.92417
Adjusted RN Staffing Hours per Resident per Day 0.25818
Adjusted Total Nurse Staffing Hours per Resident per Day 5.47939
Cycle 1 Standard Survey Health Date 11/22/2016
Cycle 2 Total Number of Health Deficiencies 3
Cycle 2 Number of Standard Health Deficiencies 3
Cycle 2 Health Deficiency Score 12
Cycle 2 Standard Health Survey Date 01/14/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 12
Cycle 3 Total Number of Health Deficiencies 1
Cycle 3 Number of Standard Health Deficiencies 1
Cycle 3 Health Deficiency Score 4
Cycle 3 Standard Health Survey Date 12/04/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 4
Total Weighted Health Survey Score 4.667
Number of Fines 1
Total Amount of Fines in Dollars $4800.00
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Northwest Florida Community Hospital (snu)

Owner Name Role Association Date
JD-MLS TRUST (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
6%
since 12/21/2012
KRIEGER, SCOTT (Individual) DIRECTOR since 12/21/2012
MARLER, ANNICE (Individual) MANAGING EMPLOYEE since 10/30/2009
SCHLENKER, PATRICK (Individual) DIRECTOR since 03/20/2004
SCHWARTZ, SHARONE (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
6%
since 12/21/2012
SHERRY LATT LOWY GRANDCHILDREN TRUST (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
5%
since 12/21/2012
SMEDRA, IRA (Individual) DIRECTOR since 12/21/2012
SMEDRA, IRA (Individual) OFFICER since 12/21/2012
STEIER, E (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
8%
since 12/21/2012
STEIER, E (Individual) DIRECTOR since 12/21/2012
STIGLER, CHARLES (Individual) DIRECTOR since 12/21/2012
WINTNER, JACOB (Individual) DIRECTOR since 12/21/2012
WINTNER, JACOB (Individual) OFFICER since 12/21/2012

32428 · Nursing Home

Washington Rehabilitation and Nursing Center 879 Usery Road, Chipley, FL 32428

Chipley · Nursing Home

Washington Rehabilitation and Nursing Center 879 Usery Road, Chipley, FL 32428

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