Blue Creek Healthcare LLC
Organization Active NPI Skilled Nursing Facility · Whitehouse, OH
NPI 1023523404 · NPPES record last updated Dec 7, 2017
Key facts
- NPI
- 1023523404
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- BLUE CREEK HEALTHCARE LLC
- Practice address
- 11239 Waterville St
Whitehouse, OH 43571-9813 - Phone
- (937) 825-6622
- NPI assigned
- Dec 7, 2017
- Organization subpart
- No
Authorized official
- Name
- Paul B Bergsten
- Title
- Managing Member
- Phone
- (937) 825-6622
Facilities with the same owner 9
Practitioners 3
-
Anu Garg, MD
-
Joseph S Peyton, D.O.
-
Sean D Stiltner, DO
Affiliated clinicians 2
-
Joseph S Peyton, D.O.
-
Sean D Stiltner, DO
Medicare Care Compare: Nursing home
- Listed as
- Whitehouse Country Manor
- Overall star rating
- ★★★★☆ 4 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★☆☆☆ 2 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Oct 4, 1989
- Medicare certification status
- Active
- Certified beds
- 90 · 85.7 residents per day on average
- Chain
- Hillstone Healthcare
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Skilled nursing facility certification: CCN 365756
- Legal name
- BLUE CREEK HEALTHCARE LLC
- Doing business as
- WHITEHOUSE COUNTRY MANOR
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 4, 1989
- Last certification
- Feb 18, 2025
- Beds
- 90
- Ownership / control type
- Corporation
- Multi-facility organization
- Hillstone Healthcare
- Most recent change of ownership
- Mar 1, 2018
- Organization structure
- LLC · Proprietary
- Incorporated
- Dec 5, 2017 in OH
- Enrollment address
- 11239 Waterville St
Whitehouse, OH 43571-9813 - Nursing home name
- WHITEHOUSE COUNTRY MANOR
- Affiliated entity
- HILLSTONE HEALTHCARE
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Paul B Bergsten |
5% Or Greater Indirect Ownership Interest | Mar 1, 2018 | 60% |
| Corporate Officer |
Mar 1, 2018 | ||
| Operational/Managerial Control |
Mar 1, 2018 | ||
| Matthew Dapore |
5% Or Greater Indirect Ownership Interest | Mar 1, 2018 | 40% |
| Corporate Officer |
Mar 1, 2018 | ||
| Operational/Managerial Control |
Mar 1, 2018 | ||
| Hillstone Healthcare Inc. |
5% Or Greater Direct Ownership Interest | Mar 1, 2018 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180423000352 | OH | Part a Provider - Skilled Nursing Facility | 8628331881 | Practice locations: Whitehouse, OH |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
11239 Waterville St
Whitehouse, OH 43571-9813
Mailing address
544 Enterprise Dr
Lewis Center, OH 43035-9704
Other providers in Whitehouse, OH
- Dawn Atugonza
- Tonya Yaros Belczyk
- Christina Bergman
- Bittersweet Inc.
- Ludivia Mae Blossom
- Jennifer Marie Bradley
- BXPQ Dental Kathryn a. Lewis, D.D.S., LLC
- Camp Courageous, Inc.
- Christine Crawford
- Isaiah Antonio Cruz
All providers in Whitehouse, 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 7, 2017. 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.