NPIMap

Organization Active NPI

Susquehanna Nursing & Rehabilitation Center, LLC

  • Skilled Nursing Facility
  • Johnson City, NY
National Provider Identifier
1285615682
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0303307N Issued in NY
Legal business name
SUSQUEHANNA NURSING & REHABILITATION CENTER, LLC
Practice address
282 Riverside Dr
Johnson City, NY 13790-2727
Phone
(607) 729-9206
Fax
(607) 797-3229
NPI assigned
Nov 11, 2005
Last updated
Sep 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ralph Rosso
Title
Cfo
Phone
(716) 829-1554

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X NU
Skilled Nursing Facility 314000000X 0303307N NY Primary

Addresses

Primary practice location

282 Riverside Dr
Johnson City, NY 13790-2727

Mailing address

282 Riverside Dr
Johnson City, NY 13790-2727
Phone (607) 729-9206

Other identifiers 3

IdentifierTypeStateIssuer
00311037MedicaidNY
00811629MedicaidNY
0303307NOtherNYOPERATING CERTIFICATE

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://urldefense.com/v3/__https:/esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service__;!!FxBh9b0Dhg!YNotywZTQPco5y2YH7CAn8wZy0i1ML5ZmZIiOGVTb0SyRowZCFpsAtBlzL-QcKJNaAltZDIuQMBfPiPbhbW77CgYe44hv0U$ Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050214000583 NY Part A Provider - Skilled Nursing Facility 0244282614 Practice locations: Johnson City, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285615682. Details of each certification follow.

Skilled nursing facility certification: CCN 335393

Legal name
SUSQUEHANNA NURSING & REHABILITATION CENTER, LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 5, 1973
Last certification
Sep 16, 2024
Beds
160
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Feb 7, 2005 in NY
Enrollment address
282 Riverside Dr
Johnson City, NY 13790-2727
Nursing home name
SUSQUEHANNA NURSING & REHABILITATION CENTER, L L C

Care Compare: Nursing home

Medicare Care Compare
Listed as
Susquehanna Nursing & Rehabilitation Center, L L CCCN 335393 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
2 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 5, 1973
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
160147.9 residents per day on average
Penalties (3 years)
1Fines totaling $32,321

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0168050Susquehanna Nursing & Rehabilitation Center LLC282 Riverside Dr, Johnson City, NY 13790Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rana Zaheer Ahmad Individual Contracted Managing EmployeeMedical Director Jan 1, 2024
Anthony Bacchi Individual 5% Or Greater Indirect Ownership Interest Feb 7, 2005 30.9%
Ralph Rosso Individual Corporate OfficerChief Financial Officer Jan 1, 2024 100%
Tom Phan Individual Operational/Managerial ControlQuality Assurance Manager/de/del Jan 1, 2020 100%
282 Riverside LLC Organization, Johnson City, NY LLC 5% Or Greater Direct Ownership Interest Feb 7, 2005 100%
Edward Oscar Farbenblum Individual 5% Or Greater Indirect Ownership Interest Jun 18, 2018 46.02%
Operational/Managerial ControlManaging Member Jun 18, 2018 46.02%
Tibor Lebovich Individual 5% Or Greater Indirect Ownership Interest Feb 7, 2005 13.5%
Timothy Reedy Individual W-2 Managing EmployeeAdministrator Jan 1, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 3

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": "1131667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727308800000",
    "number": "1285615682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "282 RIVERSIDE DR",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902727",
            "telephone_number": "607-729-9206",
            "fax_number": "607-797-3229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "282 RIVERSIDE DR",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902727",
            "telephone_number": "607-729-9206",
            "fax_number": "607-797-3229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA NURSING & REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-11",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A",
        "authorized_official_last_name": "ROSSO",
        "authorized_official_first_name": "RALPH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "716-829-1554",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "0303307N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00311037",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00811629",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPERATING CERTIFICATE",
            "identifier": "0303307N",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://urldefense.com/v3/__https:/esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service__;!!FxBh9b0Dhg!YNotywZTQPco5y2YH7CAn8wZy0i1ML5ZmZIiOGVTb0SyRowZCFpsAtBlzL-QcKJNaAltZDIuQMBfPiPbhbW77CgYe44hv0U$",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "284 Merchant St",
            "city": "Ste Genevieve",
            "state": "MO",
            "country_code": "US",
            "postal_code": "636701610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Johnson City, NY

Sources for this page

Verify at the official NPI Registry.