NPIMap

Organization Active NPI

Dublin Convalarium Operating Company, LLC

Doing business as The Convalarium

  • Skilled Nursing Facility
  • Dublin, OH
National Provider Identifier
1992321392
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
DUBLIN CONVALARIUM OPERATING COMPANY, LLC
Doing business as
The Convalarium
Practice address
6430 Post Rd
Dublin, OH 43016-1226
Phone
(614) 761-1188
NPI assigned
Jun 22, 2020
Last updated
Dec 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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

Authorized official

Name
Mr. Jeffrey Degyansky, LNHA
Title
Vice President of Operations
Phone
(330) 620-7828

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

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 names 1

  • The Convalarium Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200829000029 OH Part A Provider - Skilled Nursing Facility 1153748686 Practice locations: Dublin, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992321392. Details of each certification follow.

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
LLCProprietary
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

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Convalarium of DublinCCN 365717 · All quality measures
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
ActiveFrom the Provider of Services file
Certified beds
9080.2 residents per day on average
Chain
Lionstone Care24 facilities in the chain
Penalties (3 years)
5Fines totaling $70,901

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Convalarium at Indian Run2 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 8

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

NameRoleSinceShare
Solomon Kazarnovsky Individual 5% Or Greater Indirect Ownership InterestManaging Partner Jan 1, 2023 50%
Corporate OfficerManaging Partner Jan 1, 2023
Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023
Eliezer Goldish Individual Corporate OfficerChief Financial Officer Oct 9, 2023
Operational/Managerial Control Oct 9, 2023
Adp of the SNF Oct 9, 2023
Adam Cusner Individual Corporate OfficerChief Executive Officer Jan 27, 2025
Operational/Managerial Control Jan 27, 2025
Adp of the SNF Jan 27, 2025
Individual Adp of the SNF Aug 1, 2023
Jeffrey Degyansky Individual Corporate OfficerChief Operating Officer Jan 1, 2020
Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023
Individual Adp of the SNF Nov 4, 2024
Lionstone HZ Opco Holdings LLC Organization, Valley Stream, NY LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2023 100%
Abba Stein Individual 5% Or Greater Indirect Ownership InterestManaging Partner Jan 1, 2023 50%
Corporate OfficerManaging Partner Jan 1, 2023
Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023

Facilities with the same owner 9

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

Practitioners & affiliated clinicians

Practitioners 1

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 1

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": "1592784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1992321392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 OLD HENDERSON RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432203644",
            "telephone_number": "614-459-0445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6430 POST RD",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430161226",
            "telephone_number": "614-761-1188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUBLIN CONVALARIUM OPERATING COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-22",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "DEGYANSKY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "VICE PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "330-620-7828",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Convalarium",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Convalarium",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dublin, OH

Sources for this page

Verify at the official NPI Registry.