Aj Suburban Pavilion Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1373N Issued in OH

Legal business name

AJ SUBURBAN PAVILION OPCO LLC

Doing business as

Suburban Pavilion

Practice address

20265 Emery Rd
North Randall, OH 44128-4122

Phone

(216) 475-8880

Fax

(216) 587-4806

NPI assigned

Mar 20, 2018

Last updated

Apr 26, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Hayley B Williams

Title

Attorney

Phone

(216) 706-3936

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Suburban Pavilion Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417451949. Details of each certification follow.

• CCN 365215 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 365215

Legal name

AJ SUBURBAN PAVILION OPCO LLC

Doing business as

SUBURBAN HEALTHCARE AND REHABILITATION

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Mar 19, 1969

Last certification

Mar 7, 2024

Beds

150

Ownership / control type

Limited Liability Corporation

Most recent change of ownership

Apr 1, 2018

Organization structure

LLCProprietary

Incorporated

Dec 20, 2017 in OH

Enrollment address

20265 Emery Rd
North Randall, OH 44128-4122

Nursing home name

SUBURBAN HEALTHCARE AND REHABILITATION

Listed as

Suburban Healthcare and RehabilitationCCN 365215 · 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 19, 1969

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

150112.3 residents per day on average

Penalties (3 years)

5Fines totaling $94,587

Processed by Care Compare on Aug 1, 2026.

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.

Owners & managing parties with NPI records 1

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

• Rajesh Agarwal, M.D.

  • Specialist
  • Mayfield Heights, OH
  • NPI 1285618579

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 3

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.

• Rajesh Agarwal, M.D.

  • Specialist
  • Mayfield Heights, OH
  • NPI 1285618579
  NPD (past)
• Richard M King, MD

  • Internal Medicine Physician
  • Beachwood, OH
  • NPI 1861481350
  NPD (past)
• Miodrag Zivic, M.D.

  • Internal Medicine Physician
  • Beachwood, OH
  • NPI 1225011836
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Richard M King, MD

  • Internal Medicine Physician
  • Beachwood, OH
  • NPI 1861481350

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524700800000",
    "number": "1417451949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 ANTHONY WAYNE TRL",
            "city": "WATERVILLE",
            "state": "OH",
            "postal_code": "435661516",
            "telephone_number": "216-475-8880",
            "fax_number": "216-587-4806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20265 EMERY RD",
            "city": "NORTH RANDALL",
            "state": "OH",
            "postal_code": "441284122",
            "telephone_number": "216-475-8880",
            "fax_number": "216-587-4806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AJ SUBURBAN PAVILION OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-20",
        "last_updated": "2018-04-26",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "HAYLEY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "ATTORNEY",
        "authorized_official_telephone_number": "216-706-3936"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "1373N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO DEPARTMENT OF HEALTH",
            "identifier": "1373N",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suburban Pavilion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in North Randall, OH
• Providers in North Randall, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2018; 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.

Verify at the official NPI Registry.