Ravenswood Village
200 Ritchie Avenue, Ravenswood, WV 26164


Ravenswood Village is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 515177. The address is 200 Ritchie Avenue, Ravenswood, WV 26164. The zip code is 26164. The phone number is 3042739385.


Ravenswood Village · 200 Ritchie Avenue, Ravenswood, WV 26164

Federal Provider Number 515177
Provider Name RAVENSWOOD VILLAGE
Address 200 RITCHIE AVENUE
RAVENSWOOD, WV 26164
Phone Number 3042739385
SSA County Code 170
County Name Jackson
Ownership Type For profit - Individual
Certified Beds 62
Certified Beds Residents 57
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name 200 SOUTH RITCHIE AVENUE OPERATIONS LLC
Date First Approved to Provide Medicare Medicaid Services 01/01/2002
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 4
Health Inspection Rating 4
Quality Measure Rating 2
Staffing Rating 3
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.41667
Reported LPN Staffing Hours per Resident per Day 0.60263
Reported RN Staffing Hours per Resident per Day 0.64737
Reported Licensed Staffing Hours per Resident per Day 1.25
Reported Total Nurse Staffing Hours per Resident per Day 3.66667
Reported Physical Therapist Staffing Hours per Resident Per Day 0.03772
Expected CNA Staffing Hours per Resident per Day 2.4014
Expected LPN Staffing Hours per Resident per Day 0.65978
Expected RN Staffing Hours per Resident per Day 1.16565
Expected Total Nurse Staffing Hours per Resident per Day 4.22684
Adjusted CNA Staffing Hours per Resident per Day 2.4693
Adjusted LPN Staffing Hours per Resident per Day 0.75811
Adjusted RN Staffing Hours per Resident per Day 0.41497
Adjusted Total Nurse Staffing Hours per Resident per Day 3.4967
Cycle 1 Total Number of Health Deficiencies 4
Cycle 1 Number of Standard Health Deficiencies 4
Cycle 1 Health Deficiency Score 24
Cycle 1 Standard Survey Health Date 03/09/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 24
Cycle 2 Total Number of Health Deficiencies 8
Cycle 2 Number of Standard Health Deficiencies 8
Cycle 2 Health Deficiency Score 60
Cycle 2 Standard Health Survey Date 01/07/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 60
Cycle 3 Total Number of Health Deficiencies 5
Cycle 3 Number of Standard Health Deficiencies 5
Cycle 3 Health Deficiency Score 40
Cycle 3 Standard Health Survey Date 10/09/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 40
Total Weighted Health Survey Score 38.667
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Ravenswood Village

Owner Name Role Association Date
AMOS, TANATHA (Individual) MANAGING EMPLOYEE since 04/01/2011
BERG, MICHAEL (Individual) OFFICER since 03/02/2015
BERG, MICHAEL (Individual) OPERATIONAL/MANAGERIAL CONTROL since 03/02/2015
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 02/02/2015
GENESIS HOLDINGS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
GENESIS OPERATIONS V LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 02/02/2015
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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