NPIMap

Organization Active NPI

Otterbein Perrysburg LLC

  • Skilled Nursing Facility
  • Perrysburg, OH
National Provider Identifier
1003939786
Registry record updated Feb 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2480N Issued in OH
Legal business name
OTTERBEIN PERRYSBURG LLC
Practice address
3529 Rivers Edge Drive
Perrysburg, OH 43551
Phone
(419) 874-2428
Fax
(419) 872-8464
NPI assigned
Apr 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2015

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

Authorized official

Name
James Chris Green, CPA
Title
Treasurer & Cfo
Phone
(513) 933-5418

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2480N OH Primary

Addresses

Primary practice location

3529 Rivers Edge Drive
Perrysburg, OH 43551

Mailing address

580 N State Route 741
Lebanon, OH 45036-8839
Phone (513) 932-5401

Other identifiers 1

IdentifierTypeStateIssuer
2768107MedicaidOH

Other names 1

  • Avalon by Otterbein Perrysburg Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070620000222 OH Part A Provider - Skilled Nursing Facility 0840399671 Practice locations: Perrysburg, OH

Skilled nursing facility certification: CCN 366354

Legal name
OTTERBEIN PERRYSBURG, LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 2, 2007
Last certification
Feb 22, 2024
Beds
60
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Otterbein Senior Life
Organization structure
LLCNon-profit
Incorporated
Aug 29, 2006 in OH
Enrollment address
3525 Rivers Edge Dr
Perrysburg, OH 43551-1672
Nursing home name
AVALON BY OTTERBEIN AT PERRYSBURG
Affiliated entity
OTTERBEIN SENIORLIFE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Avalon by Otterbein at PerrysburgCCN 366354
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Oct 2, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6055.4 residents per day on average
Chain
Otterbein Seniorlife20 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
36D1072428Avalon by Otterbein Perrysburg3529 Rivers Edge Drive, Perrysburg, OH 43551Certificate of waiverAug 15, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Otterbein Neighborhoods, LLC Organization, Lebanon, OH LLC, Non-profit Operational/Managerial Control Jan 1, 2016 100%
Jill Wilson Individual Corporate OfficerPresident/Ceo May 1, 2009 100%
Daniel Arnold Individual W-2 Managing EmployeeVP Small Houses Sep 3, 2018 100%
James Christopher Green Individual Corporate OfficerVP/Treasurer/Cfo Nov 21, 2005 100%

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423440000000",
    "number": "1003939786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 N STATE ROUTE 741",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450368839",
            "telephone_number": "513-932-5401",
            "fax_number": "513-932-1054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3529 RIVERS EDGE DRIVE",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "43551",
            "telephone_number": "419-874-2428",
            "fax_number": "419-872-8464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTTERBEIN PERRYSBURG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2015-02-09",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "CHRIS",
        "authorized_official_title_or_position": "TREASURER & CFO",
        "authorized_official_telephone_number": "513-933-5418",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "2480N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2768107",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avalon by Otterbein Perrysburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Perrysburg, OH

Sources for this page

Verify at the official NPI Registry.