17322 Euclid Avenue Company LLC
Organization Active NPI Skilled Nursing Facility · Cleveland, OH
NPI 1427437698 · NPPES record last updated Jun 30, 2021
Key facts
- NPI
- 1427437698
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 0318N (OH)
- Legal business name
- 17322 EUCLID AVENUE COMPANY LLC
- Practice address
- 17322 Euclid Ave
Cleveland, OH 44112-1210 - Phone
- (216) 486-2280
- Fax
- (216) 383-4307
- NPI assigned
- May 21, 2015
- Organization subpart
- No
Authorized official
- Name
- Hayley B Williams
- Title
- Attorney
- Phone
- (216) 706-3936
Facilities with the same owner 27
Practitioners 4
-
Lokanathan Anand, MD
-
Harigopal Balaji, MD
-
Miodrag Zivic, M.D.
Affiliated clinicians 4
-
Lokanathan Anand, MD
-
Harigopal Balaji, MD
-
Miodrag Zivic, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Eastbrook Healthcare Center
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Aug 1, 1974
- Medicare certification status
- Active
- Certified beds
- 109 · 101.3 residents per day on average
- Chain
- Garden Springs Healthcare
- Penalties (3 years)
- 1 · fines totaling $23,989
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Skilled nursing facility certification: CCN 365129
- Legal name
- 17322 EUCLID AVENUE COMPANY LLC
- Doing business as
- EASTBROOK HEALTHCARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 1, 1974
- Last certification
- May 8, 2024
- Beds
- 109
- Ownership / control type
- Corporation
- Multi-facility organization
- Garden Springs
- Organization structure
- LLC · Proprietary
- Incorporated
- Apr 9, 2015 in OH
- Enrollment address
- 17322 Euclid Ave
Cleveland, OH 44112-1210 - Nursing home name
- EASTBROOK HEALTHCARE CENTER
- Affiliated entity
- GARDEN SPRINGS HEALTHCARE
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Elm Arbor, LLC |
5% Or Greater Direct Ownership Interest | Jun 4, 2019 | 10% |
| Meb Irrv TR |
5% Or Greater Direct Ownership Interest | Jun 4, 2019 | 11.25% |
| Matis Mark Friedman |
Contracted Managing Employee | Jun 15, 2015 | |
| 5% Or Greater Indirect Ownership Interest |
Jun 4, 2019 | 50% | |
| Corporate Officer |
Jun 4, 2019 | 100% | |
| Corporate Director |
Jun 4, 2019 | 100% | |
| Philipson Family Limited Liability Company, LLC |
5% Or Greater Direct Ownership Interest | Jun 4, 2019 | 15% |
| Castle Rock Nursing Member, LLC |
5% Or Greater Direct Ownership Interest | Jun 4, 2019 | 45% |
| Operational/Managerial Control | Jun 4, 2019 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150723006881 | OH | Part a Provider - Skilled Nursing Facility | 1153634969 | Practice locations: Cleveland, OH |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 0318N | OH | Yes |
Addresses
Primary practice location
17322 Euclid Ave
Cleveland, OH 44112-1210
Mailing address
17322 Euclid Ave
Cleveland, OH 44112-1210
Phone (216) 486-2280
Other names
- Eastbrook Healthcare Center
- Rudwick Manor Special Care Center
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.