Dublin Convalarium Operating Company, LLC
Organization Active NPI Skilled Nursing Facility · Dublin, OH
NPI 1992321392 · NPPES record last updated Dec 17, 2024
Key facts
- NPI
- 1992321392
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- DUBLIN CONVALARIUM OPERATING COMPANY, LLC
- Practice address
- 6430 Post Rd
Dublin, OH 43016-1226 - Phone
- (614) 761-1188
- NPI assigned
- Jun 22, 2020
- Organization subpart
- No
Authorized official
- Name
- Mr. Jeffrey Degyansky, LNHA
- Title
- Vice President of Operations
- Phone
- (330) 620-7828
Corporate family (same tax ID) 1
Facilities with the same owner 9
Practitioners 1
-
Lyle Terrance Olson, M.D.
Affiliated clinicians 1
-
Lyle Terrance Olson, M.D.
Medicare Care Compare: Nursing home
- Listed as
- The Convalarium of Dublin
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Dec 16, 1988
- Medicare certification status
- Active
- Certified beds
- 90 · 80.2 residents per day on average
- Chain
- Lionstone Care
- Penalties (3 years)
- 5 · fines totaling $70,901
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Skilled nursing facility certification: CCN 365717
- Legal name
- DUBLIN CONVALARIUM OPERATING COMPANY, LLC
- Doing business as
- THE CONVALARIUM OF DUBLIN
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Dec 16, 1988
- Last certification
- Nov 27, 2024
- Beds
- 90
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Lion Stone Care
- Organization structure
- LLC · Proprietary
- Incorporated
- Apr 27, 2020 in OH
- Enrollment address
- 6430 Post Rd
Dublin, OH 43016-1226 - Nursing home name
- THE CONVALARIUM OF DUBLIN
- Affiliated entity
- LIONSTONE CARE
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Solomon Kazarnovsky |
5% Or Greater Indirect Ownership Interest |
Jan 1, 2023 | 50% |
| Corporate Officer |
Jan 1, 2023 | ||
| Operational/Managerial Control | Jan 1, 2023 | ||
| Adp of the SNF | Jan 1, 2023 | ||
| Eliezer Goldish |
Corporate Officer |
Oct 9, 2023 | |
| Operational/Managerial Control | Oct 9, 2023 | ||
| Adp of the SNF | Oct 9, 2023 | ||
| Adam Cusner |
Corporate Officer |
Jan 27, 2025 | |
| Operational/Managerial Control | Jan 27, 2025 | ||
| Adp of the SNF | Jan 27, 2025 | ||
| |
Adp of the SNF | Aug 1, 2023 | |
| Jeffrey Degyansky |
Corporate Officer |
Jan 1, 2020 | |
| Operational/Managerial Control | Jan 1, 2023 | ||
| Adp of the SNF | Jan 1, 2023 | ||
| |
Adp of the SNF | Nov 4, 2024 | |
| Lionstone HZ Opco Holdings LLC |
5% Or Greater Direct Ownership Interest | Jan 1, 2023 | 100% |
| Abba Stein |
5% Or Greater Indirect Ownership Interest |
Jan 1, 2023 | 50% |
| Corporate Officer |
Jan 1, 2023 | ||
| Operational/Managerial Control | Jan 1, 2023 | ||
| Adp of the SNF | Jan 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200829000029 | OH | Part a Provider - Skilled Nursing Facility | 1153748686 | Practice locations: Dublin, OH |
National Provider Directory
- Tax ID family
- Convalarium at Indian Run
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
6430 Post Rd
Dublin, OH 43016-1226
Mailing address
1661 Old Henderson Rd
Columbus, OH 43220-3644
Phone (614) 459-0445
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1900N | Other | OH | LICENSURE |
Other names
- The Convalarium
Other providers in Dublin, OH
- Alaina Drysdale
- Evmy Valentina Duarte
- Dublin Chiropractic Center, Inc.
- Dublin City Schools
- Dublin Convalarium Operating Company, LLC
- Dublin Counseling Group, LLC
- Dublin Diagnostic Imaging LLC
- Dublin Direct Care LLC
- Dublin Endodontics LLC
- Dublin Family Care, Inc.
All providers in Dublin, OH · Skilled Nursing Facility in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.