Shenandoah Center
50 Mulberry Tree Street, Charles Town, WV 25414


Shenandoah Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 515167. The address is 50 Mulberry Tree Street, Charles Town, WV 25414. The zip code is 25414. The phone number is 3047241101.


Shenandoah Center · 50 Mulberry Tree Street, Charles Town, WV 25414

Federal Provider Number 515167
Provider Name SHENANDOAH CENTER
Address 50 MULBERRY TREE STREET
CHARLES TOWN, WV 25414
Phone Number 3047241101
SSA County Code 180
County Name Jefferson
Ownership Type For profit - Corporation
Certified Beds 78
Certified Beds Residents 74
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name 50 MULBERRY TREE STREET OPERATIONS LLC
Date First Approved to Provide Medicare Medicaid Services 04/16/1998
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 3
Health Inspection Rating 3
Quality Measure Rating 3
Staffing Rating 2
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 1.89662
Reported LPN Staffing Hours per Resident per Day 0.64459
Reported RN Staffing Hours per Resident per Day 0.80743
Reported Licensed Staffing Hours per Resident per Day 1.45203
Reported Total Nurse Staffing Hours per Resident per Day 3.34864
Reported Physical Therapist Staffing Hours per Resident Per Day 0.00068
Expected CNA Staffing Hours per Resident per Day 2.4861
Expected LPN Staffing Hours per Resident per Day 0.73812
Expected RN Staffing Hours per Resident per Day 1.21777
Expected Total Nurse Staffing Hours per Resident per Day 4.44199
Adjusted CNA Staffing Hours per Resident per Day 1.8719
Adjusted LPN Staffing Hours per Resident per Day 0.72483
Adjusted RN Staffing Hours per Resident per Day 0.49542
Adjusted Total Nurse Staffing Hours per Resident per Day 3.03874
Cycle 1 Total Number of Health Deficiencies 4
Cycle 1 Number of Standard Health Deficiencies 4
Cycle 1 Health Deficiency Score 28
Cycle 1 Standard Survey Health Date 05/04/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 28
Cycle 2 Total Number of Health Deficiencies 10
Cycle 2 Number of Standard Health Deficiencies 6
Cycle 2 Number of Complaint Health Deficiencies 4
Cycle 2 Health Deficiency Score 76
Cycle 2 Standard Health Survey Date 04/14/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 76
Cycle 3 Total Number of Health Deficiencies 15
Cycle 3 Number of Standard Health Deficiencies 14
Cycle 3 Number of Complaint Health Deficiencies 1
Cycle 3 Health Deficiency Score 72
Cycle 3 Standard Health Survey Date 08/29/2013
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 72
Total Weighted Health Survey Score 51.333
Number of Substantiated Complaints 6
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Shenandoah Center

Owner Name Role Association Date
BERG, MICHAEL (Individual) OFFICER since 12/01/2012
BERG, MICHAEL (Individual) OPERATIONAL/MANAGERIAL CONTROL since 12/01/2012
CORNWELL, MICHELE (Individual) MANAGING EMPLOYEE since 04/01/2011
DAVIS, KEITH (Individual) OPERATIONAL/MANAGERIAL CONTROL since 03/02/2015
DONNA REIS 1995 FAM TR (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
EDWARDS, JAN (Individual) OFFICER since 03/02/2015
FC-GEN OPERATIONS INVESTMENT LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
FISHMAN, STEVEN (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
GEN OPERATIONS I LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
GEN OPERATIONS II, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
GENERAL ELECTRIC CAPITAL CORPORATION (Organization) 5% OR GREATER SECURITY INTEREST since 02/02/2015
GENESIS HEALTHCARE INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
GENESIS HEALTHCARE LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
GENESIS HEALTHCARE LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 04/01/2011
GENESIS HOLDINGS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
GENESIS OPERATIONS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
GENESIS WV HOLDINGS LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 04/01/2011
GHC HOLDINGS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
HCCF MANAGEMENT GROUP XI LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
MASON, JOSEPH (Individual) OFFICER since 03/02/2015
NAUSE, KEITH (Individual) OFFICER since 03/02/2015
ONEX PARTNERS LP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
SENIOR CARE GENESIS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
SENIOR CARE HOLDINGS, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
SHERMAN, MICHAEL (Individual) OFFICER since 03/02/2015
SUN HEALTHCARE GROUP, INC. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
SUNDANCE REHABILITATION HOLDCO, INC. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2016
WHITMAN, ARNOLD (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
ZAC PROPERTIES XI LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015

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