NPIMap

Organization Active NPI

Pavilion at Stow, LLC

Doing business as The Pavilion at Stow for Nursing and Rehabilitation

  • Skilled Nursing Facility
  • Stow, OH
National Provider Identifier
1508686429
Registry record updated Apr 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PAVILION AT STOW, LLC
Doing business as
The Pavilion at Stow for Nursing and Rehabilitation
Practice address
3700 Englewood Dr
Stow, OH 44224-3204
Phone
(330) 688-1828
NPI assigned
Oct 15, 2024
Last updated
Apr 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2025

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

Authorized official

Name
Kymberly Lavin
Title
Executive Assistant
Phone
(516) 865-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

3700 Englewood Dr
Stow, OH 44224-3204

Mailing address

1 Valley Greens Dr
Valley Stream, NY 11581-3634
Phone (516) 865-1500

Other names 1

  • The Pavilion at Stow for Nursing and Rehabilitation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250318001083 OH Part A Provider - Skilled Nursing Facility 5597287730 Practice locations: Stow, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508686429. Details of each certification follow.

Skilled nursing facility certification: CCN 365858

Legal name
PAVILION AT STOW, LLC.
Doing business as
THE PAVILION AT STOW FOR NURSING AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 10, 1992
Last certification
Aug 21, 2023
Beds
62 (51 certified)
Ownership / control type
Corporation
Multi-facility organization
500 Selfridge Holdings, LLC
Most recent change of ownership
Aug 1, 2013
Organization structure
LLCProprietary
Enrollment address
3700 Englewood Dr
Stow, OH 44224-3204
Nursing home name
THE PAVILION AT STOW FOR NURSING AND REHABILITATIO
Affiliated entity
THE PAVILION GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Pavilion at Stow for Nursing and RehabilitatioCCN 365858 · All quality measures
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jan 10, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5144.0 residents per day on average
Chain
The Pavilion Group6 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Pavilion at Stow LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Tyler Evans Individual 5% Or Greater Indirect Ownership Interest Feb 6, 2025
Stow Group Holdings, LLC Organization, Valley Stream, NY LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Feb 6, 2025 100%
Adp of the SNF Feb 6, 2025
Npnh1 LLC Organization, Miami Beach, FL LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 6, 2025 15%
Adp of the SNF Feb 6, 2025
Ezra Birnbaum Individual 5% Or Greater Indirect Ownership Interest Feb 6, 2025 15%
Adp of the SNF Feb 6, 2025
Stow Property, LLC Organization, Valley Stream, NY LLC Adp of the SNF Feb 6, 2025
Stephen Keller Individual Operational/Managerial Control Feb 6, 2025
Adp of the SNF Feb 6, 2025
Stow Property Holdings, LLC Organization, Valley Stream, NY LLC, Holding company Adp of the SNF Feb 6, 2025
Acm Ashem Holdings, LLC Organization, Valley Stream, NY LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 6, 2025 55.5%
Adp of the SNF Feb 6, 2025
Jose Dy Individual Adp of the SNF Feb 6, 2025
Shaye Hirsch Individual 5% Or Greater Indirect Ownership Interest Feb 6, 2025 5%
Adp of the SNF Feb 6, 2025
Rafael Moerman Individual 5% Or Greater Indirect Ownership InterestCeo Feb 6, 2025 55.5%
Operational/Managerial Control Feb 6, 2025
Managing Control - Governing BodyCeo Feb 6, 2025
Adp of the SNF Feb 6, 2025
Stow Property Roll Up, LLC Organization, Valley Stream, NY LLC Adp of the SNF Feb 6, 2025
SHS Keren LLC Organization, Cedarhurst, NY LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 6, 2025 5%
Adp of the SNF Feb 6, 2025
Simcha Schonfeld Individual 5% Or Greater Indirect Ownership Interest Feb 6, 2025 22.5%
Adp of the SNF Feb 6, 2025

Owners & managing parties with NPI records 1

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

Facilities with the same owner 9

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

Practitioners & affiliated clinicians

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.

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": "1728950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743552000000",
    "number": "1508686429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 VALLEY GREENS DR",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115813634",
            "telephone_number": "516-865-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 ENGLEWOOD DR",
            "city": "STOW",
            "state": "OH",
            "postal_code": "442243204",
            "telephone_number": "330-688-1828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVILION AT STOW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-15",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A",
        "authorized_official_last_name": "LAVIN",
        "authorized_official_first_name": "KYMBERLY",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "516-865-1500"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Pavilion at Stow for Nursing and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Pavilion at Stow for Nursing and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stow, OH

Sources for this page

Verify at the official NPI Registry.