NPIMap

Organization Active NPI

Pavilion at Piketon for Nursing and Rehabilitation LLC

Doing business as The Pavilion at Piketon

  • Skilled Nursing Facility
  • Piketon, OH
National Provider Identifier
1598260952
Registry record updated Jul 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PAVILION AT PIKETON FOR NURSING AND REHABILITATION LLC
Doing business as
The Pavilion at Piketon
Practice address
7143 US Highway 23
Piketon, OH 45661-9527
Phone
(740) 289-2394
Fax
(740) 289-2231
NPI assigned
Mar 28, 2018
Last updated
Jul 10, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2019

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

Authorized official

Name
Rafael A Moerman
Title
Managing Member
Phone
(848) 299-3662

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Care Agency 251J00000X 1621N OH
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

7143 US Highway 23
Piketon, OH 45661-9527

Mailing address

1 Valley Greens Dr
Valley Stream, NY 11581-3634
Phone (848) 299-3662

Other names 1

  • The Pavilion at Piketon Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181017002071 OH Part A Provider - Skilled Nursing Facility 2668724774 Practice locations: Piketon, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598260952. Details of each certification follow.

Skilled nursing facility certification: CCN 365446

Legal name
PAVILION AT PIKETON FOR NURSING AND REHABILITATION LLC
Doing business as
THE PAVILION AT PIKETON
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 8, 1980
Last certification
Apr 17, 2025
Beds
155
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Pavilion Mangement
Most recent change of ownership
Jun 1, 2018
Organization structure
LLCProprietary
Incorporated
Feb 5, 2018 in OH
Enrollment address
7143 Route 23 S
Piketon, OH 45661
Nursing home name
THE PAVILION AT PIKETON
Affiliated entity
THE PAVILION GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Pavilion at PiketonCCN 365446 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
1 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Feb 8, 1980
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
15584.9 residents per day on average
Chain
The Pavilion Group6 facilities in the chain

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
36D0350848Pavilion at Piketon for Nursing, the7143 US Route 23 S, Piketon, OH 45661Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Pavilion Healthcare Group LLC Organization, Valley Stream, NY LLC, Management services company Adp of the SNF Jun 1, 2018
Piketon Holdings LLC Organization, Piketon, OH Created for acquisition, LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 1, 2018 100%
Adp of the SNF Jun 1, 2018
Organization, Princeton, NJ LLC Adp of the SNF Dec 1, 2025
Ydr 18 LLC Organization, New York, NY LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 1, 2018 65%
Adp of the SNF Jun 1, 2018
Organization, New York, NY Adp of the SNF Dec 1, 2025
Individual Adp of the SNF Jun 1, 2018
Organization, New York, NY LLC Adp of the SNF Dec 1, 2025
Organization, Chillicothe, OH LLC, Medical staffing company Adp of the SNF Dec 1, 2025
101 LLC Organization, Park Ridge, NJ LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 1, 2018 45.5%
Adp of the SNF Jun 1, 2018
Individual Adp of the SNF Jun 1, 2018
Riki Rimberg Individual Adp of the SNF Jun 1, 2018
Acm Ashem Holdings, LLC Organization, Valley Stream, NY LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 1, 2018 17.5%
Adp of the SNF Jun 1, 2018
Dirk N Juschka Individual Adp of the SNF Jun 1, 2018
Akiva Krieser Individual Operational/Managerial Control Jun 1, 2018
Individual Adp of the SNF Jun 1, 2018
Rafael Moerman Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2018 17.5%
Yp 18 LLC Organization, Park Ridge, NJ LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 1, 2018 19.5%
Adp of the SNF Jun 1, 2018
Tara Ramsey Individual Operational/Managerial Control Jun 1, 2018
Adp of the SNF Jun 1, 2018
Nechemia M Lieberman Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2018 17.5%
Adp of the SNF Jun 1, 2018

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": "1522195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562716800000",
    "number": "1598260952",
    "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": "848-299-3662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7143 US HIGHWAY 23",
            "city": "PIKETON",
            "state": "OH",
            "postal_code": "456619527",
            "telephone_number": "740-289-2394",
            "fax_number": "740-289-2231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVILION AT PIKETON FOR NURSING AND REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-28",
        "last_updated": "2019-07-10",
        "status": "A",
        "authorized_official_last_name": "MOERMAN",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "848-299-3662"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "OH",
            "license": "1621N",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Pavilion at Piketon",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Pavilion at Piketon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Piketon, OH

Sources for this page

Verify at the official NPI Registry.