NPIMap

Organization Active NPI

Majestic Care of Fairfield LLC

  • Skilled Nursing Facility
  • Fairfield, OH
National Provider Identifier
1730793779
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MAJESTIC CARE OF FAIRFIELD LLC
Practice address
5200 Camelot Dr
Fairfield, OH 45014-4009
Phone
(513) 829-8100
NPI assigned
Sep 8, 2020
Last updated
Jul 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

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

Authorized official

Name
Paul Pruitt
Title
Officer
Phone
(317) 288-4029

Specialties & licenses 1

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

Addresses

Primary practice location

5200 Camelot Dr
Fairfield, OH 45014-4009

Mailing address

777 E Main St Ste 210
Westfield, IN 46074-5301

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201027003135 OH Part A Provider - Skilled Nursing Facility 8921418252 Practice locations: Fairfield, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730793779. Details of each certification follow.

Skilled nursing facility certification: CCN 365396

Legal name
MAJESTIC CARE OF FAIRFIELD LLC
Doing business as
MAJESTIC CARE OF FAIRFIELD
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 20, 1978
Last certification
Sep 21, 2023
Beds
200
Ownership / control type
Individual
Multi-facility organization
MAJESTIC CARE
Most recent change of ownership
Sep 30, 2020
Organization structure
LLCProprietary
Incorporated
Aug 25, 2020 in OH
Enrollment address
5200 Camelot Dr
Fairfield, OH 45014-4009
Nursing home name
MAJESTIC CARE OF FAIRFIELD LLC
Affiliated entity
MAJESTIC CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Majestic Care of Fairfield LLCCCN 365396 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
Nov 20, 1978
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
200142.3 residents per day on average
Chain
Majestic Care22 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
36D0344978Majestic Care of Fairfield5200 Camelot Drive, Fairfield, OH 45014Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Majestic Management LLC Organization, Westfield, IN LLC, Management services company Operational/Managerial Control Oct 1, 2020
Adp of the SNF Jul 11, 2025
Asad Ali Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Angela Rewa Individual Operational/Managerial Control Oct 23, 2023
Adp of the SNF Oct 23, 2023
Robert Laron Russell Individual Operational/Managerial Control Apr 8, 2024
Adp of the SNF Apr 8, 2024
RB SNF Operations Holdings LLC Organization, Flushing, NY Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 1, 2020 100%
Paul Pruitt Individual Operational/Managerial Control May 1, 2023
Managing Control - Governing BodyCeo May 1, 2023
Adp of the SNF Oct 1, 2023
5200 Camelot Drive SNF Realty LLC Organization, Flushing, NY LLC Operational/Managerial Control Oct 1, 2020
Adp of the SNF Oct 1, 2020
RB SNF Real Estate Holdings LLC Organization, Flushing, NY LLC Adp of the SNF Oct 1, 2020
Margaret Chamberlain Individual Operational/Managerial Control Sep 11, 2023
Adp of the SNF Sep 11, 2023
Anzhelika Shatrov Individual Operational/Managerial Control Dec 2, 2024
Adp of the SNF Dec 2, 2024
David Marx Individual 5% Or Greater Indirect Ownership Interest Aug 25, 2020 100%
Operational/Managerial ControlSole Managing Member of the Sole Oct 1, 2020
Adp of the SNF Oct 1, 2020
Brian Gibboney Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Eric Wolfe Individual Operational/Managerial Control Sep 11, 2023
Adp of the SNF Sep 11, 2023

Owners & managing parties with NPI records 2

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

Facilities with the same owner 20

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

View all 20

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 2

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": "1599523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1730793779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 E MAIN ST STE 210",
            "city": "WESTFIELD",
            "state": "IN",
            "postal_code": "460745301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 CAMELOT DR",
            "city": "FAIRFIELD",
            "state": "OH",
            "postal_code": "450144009",
            "telephone_number": "513-829-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAJESTIC CARE OF FAIRFIELD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-08",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A",
        "authorized_official_last_name": "PRUITT",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "317-288-4029"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, OH

Sources for this page

Verify at the official NPI Registry.