NPIMap

Organization Active NPI

Aj Candlewood Park Opco LLC

  • Skilled Nursing Facility
  • Cleveland, OH
National Provider Identifier
1497259923
Registry record updated Apr 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
1426N Issued in OH
Legal business name
AJ CANDLEWOOD PARK OPCO LLC
Practice address
1835 Belmore Rd
Cleveland, OH 44112-4301
Phone
(216) 268-3600
Fax
(216) 761-1322
NPI assigned
Mar 20, 2018
Last updated
Apr 26, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2018

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

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 1426N OH Primary

Addresses

Primary practice location

1835 Belmore Rd
Cleveland, OH 44112-4301

Mailing address

555 Anthony Wayne TRL
Waterville, OH 43566-1516
Phone (330) 720-0406

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180628002474 OH Part A Provider - Skilled Nursing Facility 5193071413 Practice locations: East Cleveland, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497259923. Details of each certification follow.

Skilled nursing facility certification: CCN 365353

Legal name
AJ CANDLEWOOD PARK OPCO LLC
Doing business as
CANDLEWOOD HEALTHCARE AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 16, 1977
Last certification
Sep 27, 2022
Beds
116
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Certus Healthcare
Organization structure
LLCProprietary
Incorporated
Dec 20, 2017 in OH
Enrollment address
1835 Belmore Rd
East Cleveland, OH 44112-4301
Nursing home name
CANDLEWOOD HEALTHCARE AND REHABILITATION
Affiliated entity
CERTUS HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Candlewood Healthcare and RehabilitationCCN 365353 · All quality measures
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 - Limited Liability company
Certified
May 16, 1977
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
11689.8 residents per day on average
Chain
Certus Healthcare14 facilities in the chain
Penalties (3 years)
1Fines totaling $29,488

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Shmuel Fishman Individual 5% Or Greater Indirect Ownership InterestCfo and Class a Member Apr 1, 2018 37%
Corporate OfficerCfo Apr 1, 2018 50%
W-2 Managing EmployeeCfo Apr 1, 2018 50%
Mark Neuman Individual 5% Or Greater Indirect Ownership InterestClass B Member Apr 1, 2018 10%
Yisrael Friedman Individual 5% Or Greater Indirect Ownership InterestClass B Member Apr 1, 2018 10%
Aj R&R Holding Company LLC Organization, Waterville, OH Created for acquisition, Holding company 5% Or Greater Direct Ownership Interest Apr 1, 2018 100%
Operational/Managerial Control Apr 1, 2018 100%
Extended Ohio LLC Organization, Howell, NJ LLC 5% Or Greater Indirect Ownership Interest Apr 1, 2018 10%
Jason Dipasqua Individual 5% Or Greater Indirect Ownership InterestCoo and Class a Member Apr 1, 2018 31%
Corporate OfficerCoo Apr 1, 2018 50%
W-2 Managing EmployeeCoo Apr 1, 2018 50%

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

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 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": "1521504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524700800000",
    "number": "1497259923",
    "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": "330-720-0406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 BELMORE RD",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441124301",
            "telephone_number": "216-268-3600",
            "fax_number": "216-761-1322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AJ CANDLEWOOD PARK 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": "1426N",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.