Active NPI
RG Legacy II LLC
- Skilled Nursing Facility
- Pasadena, CA
National Provider Identifier
1225637994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- RG LEGACY II LLC
- Practice address
- 1570 N Fair Oaks Ave
Pasadena, CA 91103-1822 - Phone
- (626) 798-0558
- Fax
- (626) 798-8240
- NPI assigned
- Oct 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ezequiel Bercovich
- Title
- Manager
- Phone
- (213) 948-0793
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
1570 N Fair Oaks Ave
Pasadena, CA 91103-1822
Mailing address
1570 N Fair Oaks Ave
Pasadena, CA 91103-1822
Phone (626) 798-1111
Other names 1
- Pasadena Nursing Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220223002971 | CA | Part A Provider - Skilled Nursing Facility | 4082008743 | Practice locations: Pasadena, CA |
Skilled nursing facility certification: CCN 555893
- Legal name
- RG LEGACY II, LLC
- Doing business as
- PASADENA NURSING CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 5, 2015
- Last certification
- Mar 20, 2025
- Beds
- 52
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Betenu Health
- Organization structure
- LLC
- Enrollment address
- 1570 N Fair Oaks Ave
Pasadena, CA 91103-1822 - Nursing home name
- PASADENA NURSING CENTER
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Pasadena Nursing Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Aug 5, 2015
- Medicare certification status
- Active
- Certified beds
- 52
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 3
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 9
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Arlene H Rosales | Adp of the SNF | Dec 28, 2017 | |
| Shahrzad Jannat | Operational/Managerial Control | Mar 13, 2024 | |
| Adp of the SNF | Mar 13, 2024 | ||
| Mayer Family 2016 Irrevocable Trust | 5% Or Greater Direct Ownership Interest | Oct 1, 2020 | 20% |
| Ori Management LLC | 5% Or Greater Direct Ownership Interest | Oct 10, 2023 | 12.5% |
| Jacob Unger | 5% Or Greater Indirect Ownership Interest | Oct 1, 2020 | 20% |
| Indirect Ownership Interest | Aug 20, 2020 | 20% | |
| Adp of the SNF | Dec 28, 2017 | ||
| Ezequiel Bercovich | 5% Or Greater Direct Ownership Interest | Dec 31, 2022 | 20% |
| Adam Zenou | 5% Or Greater Direct Ownership Interest | Oct 1, 2020 | 20% |
| Moises Bercovich | 5% Or Greater Direct Ownership Interest | Oct 1, 2020 | 20% |
Practitioners & affiliated clinicians
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603324800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1728604800000",
"number": "1225637994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1570 N FAIR OAKS AVE",
"city": "PASADENA",
"state": "CA",
"postal_code": "911031822",
"telephone_number": "626-798-1111",
"fax_number": "626-374-1901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1570 N FAIR OAKS AVE",
"city": "PASADENA",
"state": "CA",
"postal_code": "911031822",
"telephone_number": "626-798-0558",
"fax_number": "626-798-8240"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RG LEGACY II LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-10-22",
"last_updated": "2024-10-11",
"certification_date": "2024-10-11",
"status": "A",
"authorized_official_last_name": "BERCOVICH",
"authorized_official_first_name": "EZEQUIEL",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "213-948-0793"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Pasadena Nursing Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Pasadena Nursing Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.