Kennedy Pavilion RH, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

7003417N Issued in NY

Legal business name

KENNEDY PAVILION RH, LLC

Doing business as

The Pavilion at Queens for Rehabilitation & Nursing

Practice address

3617 Parsons Blvd
Flushing, NY 11354-5931

Phone

(718) 888-5200

NPI assigned

May 4, 2016

Last updated

Aug 14, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joel Edelstein

Title

Managing Member

Phone

(718) 888-5206

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• The Pavilion at Queens for Rehabilitation & Nursing Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871948299. Details of each certification follow.

• CCN 335804 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 335804

Legal name

KENNEDY PAVILION RH LLC

Doing business as

THE PAVILLION AT QUEENS FOR REHABILITATION & NURSING

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Dec 29, 1997

Last certification

Nov 20, 2024

Beds

302

Ownership / control type

Partnership

Most recent change of ownership

May 19, 2017

Organization structure

LLCProprietary

Incorporated

Nov 3, 2015 in NY

Enrollment address

3617 Parsons Blvd
Flushing, NY 11354-5931

Nursing home name

THE PAVILION AT QUEENS FOR REHABILITATION & NURSING

Listed as

The Pavilion at Queens for Rehabilitation & NursinCCN 335804 · All quality measures

Overall star rating

3 of 5

Health inspections

2 of 5

Staffing

3 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Partnership

Certified

Dec 29, 1997

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

302295.3 residents per day on average

Processed by Care Compare on Aug 1, 2026.

All disclosed owners & managing parties 8

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

Owners & managing parties with NPI records 1

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

• Olaf Butchma, DO

  • Internal Medicine Physician
  • Westhampton, NY
  • NPI 1326037474

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 5

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.

• Olaf Butchma, DO

  • Internal Medicine Physician
  • Westhampton, NY
  • NPI 1326037474
  NPD (past)
• Devang Dave, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Flushing, NY
  • NPI 1487728317
  NPD (past)
• Qinghong Huang, M.D.

  • Internal Medicine Physician
  • Elmhurst, NY
  • NPI 1316022510
  NPD (past)
• Muhammad Ramzan, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Flushing, NY
  • NPI 1750349254
  NPD (past)
• Alireza Shirvani, M.D.

  • Hospitalist Physician
  • Great Neck, NY
  • NPI 1073769154
  NPD (past)

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Devang Dave, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Flushing, NY
  • NPI 1487728317

  Nursing home

  Care Compare affiliation
• Qinghong Huang, M.D.

  • Internal Medicine Physician
  • Elmhurst, NY
  • NPI 1316022510

  Nursing home

  Care Compare affiliation
• Pulat Pulatov

  • Family Medicine Physician
  • Glendale, NY
  • NPI 1437579166

  Nursing home

  Care Compare affiliation
• Muhammad Ramzan, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Flushing, NY
  • NPI 1750349254

  Nursing home

  Care Compare affiliation
• Alireza Shirvani, M.D.

  • Hospitalist Physician
  • Great Neck, NY
  • NPI 1073769154

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723593600000",
    "number": "1871948299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3617 PARSONS BLVD",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113545931",
            "telephone_number": "718-888-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3617 PARSONS BLVD",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113545931",
            "telephone_number": "718-888-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY PAVILION RH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-04",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A",
        "authorized_official_last_name": "EDELSTEIN",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "718-888-5206"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "7003417N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1791900",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Pavilion at Queens for Rehabilitation & Nursing",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Pavilion at Queens for Rehabilitation & Nursing",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mona L Kelly
• Shantell Kelly
• John Kemp Jr., PHARMD
• Akiva Kenigsberg, DPM
• Kennedy Pavilion RH I, LLC (The Pavilion at Queens for Rehabilitation and Nursing)
• Rosalia Kennedy, MSED BCBA
• Hiromi Kenny
• Kent Senior Care
• Kent Senior Care Inc.
• Thomas Zoltan Kent, DMD

• Skilled Nursing Facility in Flushing, NY
• Providers in Flushing, NY by specialty
• Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.