Pavilion at Canal Fulton LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 1456866037 Enrollment ID O20250714001054

Linked facilitiesFacilities

StatesStates

16 parties: 8 organizations · 8 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Canal Group Holdings LLC	1658886262	Organization	5% or Greater Direct Ownership Interest; Operational/Managerial Control	100
Rafael Moerman	7012283047	Individual	5% or Greater Indirect Ownership Interest; Operational/Managerial Control; Managing Control - Governing Body	55.5
Matthew Kodrin	6901209055	Individual	Operational/Managerial Control; ADP of the SNF	—
Acm Ashem Holdings, LLC	5395115109	Organization	5% or Greater Indirect Ownership Interest	55.5
Simcha Schonfeld	9830629617	Individual	5% or Greater Indirect Ownership Interest; ADP of the SNF	22.5
Shaye Hirsch	6305245077	Individual	5% or Greater Indirect Ownership Interest; ADP of the SNF	22.5
Ezra Birnbaum	1850790528	Individual	5% or Greater Indirect Ownership Interest	15
NPNH1 LLC	1456750124	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	15
Shs Keren LLC	9739559543	Organization	5% or Greater Indirect Ownership Interest	5
Tyler Evans	0446774111	Individual	5% or Greater Indirect Ownership Interest	2
Bankwell	4789111600	Organization	ADP of the SNF	—
Quality Healthcare Resources	4587989157	Organization	ADP of the SNF	—
The Pavilion Managment Company LLC	0143730085	Organization	ADP of the SNF	—
High MILL Holdings LLC	8527573153	Organization	ADP of the SNF	—
Jyothi Gudla	1254318975	Individual	ADP of the SNF	—
Kenneth J Biros	5991602575	Individual	ADP of the SNF	—

Canal Group Holdings LLCPAC 1658886262
Organization1005% or Greater Direct Ownership Interest; Operational/Managerial Control
Rafael MoermanPAC 7012283047
Individual55.55% or Greater Indirect Ownership Interest; Operational/Managerial Control
Matthew KodrinPAC 6901209055
IndividualOperational/Managerial Control; ADP of the SNF
Acm Ashem Holdings, LLCPAC 5395115109
Organization55.55% or Greater Indirect Ownership Interest
Simcha SchonfeldPAC 9830629617
Individual22.55% or Greater Indirect Ownership Interest; ADP of the SNF
Shaye HirschPAC 6305245077
Individual22.55% or Greater Indirect Ownership Interest; ADP of the SNF
Ezra BirnbaumPAC 1850790528
Individual155% or Greater Indirect Ownership Interest
NPNH1 LLCPAC 1456750124
Organization155% or Greater Indirect Ownership Interest; ADP of the SNF
Shs Keren LLCPAC 9739559543
Organization55% or Greater Indirect Ownership Interest
Tyler EvansPAC 0446774111
Individual25% or Greater Indirect Ownership Interest
BankwellPAC 4789111600
OrganizationADP of the SNF
Quality Healthcare ResourcesPAC 4587989157
OrganizationADP of the SNF
The Pavilion Managment Company LLCPAC 0143730085
OrganizationADP of the SNF
High MILL Holdings LLCPAC 8527573153
OrganizationADP of the SNF
Jyothi GudlaPAC 1254318975
IndividualADP of the SNF
Kenneth J BirosPAC 5991602575
IndividualADP of the SNF

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
The Pavilion at Canal Fulton for Nursing and Rehab Pavilion at Canal Fulton LLC 38 residents		Other disclo…	3.35	Ovr★★☆☆☆Stf★☆☆☆☆Ins★★★☆☆QM★★★★☆	38

The Pavilion at Canal Fulton for Nursing and Rehab
Pavilion at Canal Fulton LLC
Other disclosed role38 res3.35 HPRD
Overall 2Staffing Staff 1

1 CMS ownership change record (showing 1)

Effective	Facility	Buyer	Seller	Side
12/16/2024	The Pavilion at Canal Fulton for Nursing and Rehab	Pavilion at Canal Fulton LLC	Gaslite Leasing LLC	Buyer

12/16/2024
The Pavilion at Canal Fulton for Nursing and Rehab (Buyer)
Gaslite Leasing LLC → Pavilion at Canal Fulton LLC

Related CMS associates

Name match to Pavilion at Canal Fulton LLC in FEC filings. Similar names may appear—confirm on FEC.gov.