NPIMap

Organization Active NPI

Copper Knoll Health and Rehab LLC

  • Skilled Nursing Facility
  • Washington Court House, OH
National Provider Identifier
1013763309
Registry record updated Apr 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
COPPER KNOLL HEALTH AND REHAB LLC
Practice address
201 Courthouse Pkwy
Washington Court House, OH 43160-6001
Phone
(740) 895-6101
NPI assigned
Apr 26, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2024

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

Authorized official

Name
Mr. Cullen Scott Gibson
Title
Vice President
Phone
(765) 664-5400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

201 Courthouse Pkwy
Washington Court House, OH 43160-6001

Mailing address

1800 N Wabash Rd
Marion, IN 46952-1300
Phone (765) 664-5400

Other names 1

  • COPPER KNOLL HEALTH AND REHAB Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240919003702 OH Part A Provider - Skilled Nursing Facility 8325589112 Practice locations: Washington Court House, OH

Skilled nursing facility certification: CCN 366417

Legal name
COPPER KNOLL HEALTH AND REHAB LLC
Doing business as
TENDER LOVING CARE MANAGEMENT
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 15, 2014
Last certification
Jun 8, 2023
Beds
75
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PLC Management
Organization structure
LLCProprietary
Incorporated
Apr 12, 2024 in OH
Enrollment address
201 Courthouse Pkwy
Washington Court House, OH 43160-6001
Nursing home name
COPPER KNOLL HEALTH & REHAB LLC
Affiliated entity
TLC MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Copper Knoll Health & Rehab LLCCCN 366417
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
For profit - Limited Liability company
Certified
Jul 15, 2014
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7564.9 residents per day on average
Chain
TLC Management20 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

201 Courthouse Pkwy
Washington Court House, OH 43160
Phone (740) 895-6101

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Ryan Ott Individual Corporate OfficerPresident Apr 12, 2024 4.99%
Adp of the SNF Dec 12, 2024
Direct Ownership Interest Apr 12, 2024 4.99%
Kaleena Patton Individual W-2 Managing EmployeeAd; Jun 17, 2024
Adp of the SNF Jan 24, 2025
Cullen S Gibson Individual Corporate OfficerVice President Apr 12, 2024 4.99%
Adp of the SNF Dec 12, 2024
Direct Ownership Interest Apr 12, 2024 4.99%
Gary L Ott Individual 5% Or Greater Direct Ownership InterestChairman Apr 12, 2024 64.98%
Corporate OfficerChairman Apr 12, 2024 64.98%
Adp of the SNF Dec 12, 2024
Dirk N Juschka Individual Adp of the SNF Dec 13, 2024
Dwight a Ott Individual 5% Or Greater Direct Ownership InterestSecretary/Treasurer Apr 12, 2024 25.04%
Corporate OfficerSecretary/Treasurer Apr 12, 2024 25.04%
Adp of the SNF Dec 12, 2024
Tender Loving Care Management Inc Organization, Marion, IN Corporation, Management services company Operational/Managerial Control Dec 11, 2024
Adp of the SNF Dec 11, 2024

Owners & managing parties with NPI records 1

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

Facilities with the same owner 19

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

View all 19

Practitioners & affiliated clinicians

Practitioners 4

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": "1714089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714089600000",
    "number": "1013763309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 N WABASH RD",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469521300",
            "telephone_number": "765-664-5400",
            "fax_number": "765-568-7182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 COURTHOUSE PKWY",
            "city": "WASHINGTON COURT HOUSE",
            "state": "OH",
            "postal_code": "431606001",
            "telephone_number": "740-895-6101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPPER KNOLL HEALTH AND REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-26",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "CULLEN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "765-664-5400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COPPER KNOLL HEALTH AND REHAB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington Court House, OH

Sources for this page

Verify at the official NPI Registry.