NPIMap

Organization Active NPI

Locust Ridge Healthcare LLC

  • Skilled Nursing Facility
  • Williamsburg, OH
National Provider Identifier
1033689385
Registry record updated Nov 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LOCUST RIDGE HEALTHCARE LLC
Practice address
12745 Elm Corner Rd
Williamsburg, OH 45176-9621
Phone
(937) 444-2920
Fax
(937) 444-1009
NPI assigned
Nov 29, 2018
Last updated
Nov 29, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2018

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

Authorized official

Name
Hayley B Williams
Title
Attorney
Phone
(216) 706-3936

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

12745 Elm Corner Rd
Williamsburg, OH 45176-9621

Mailing address

15 America Ave Unit 304
Lakewood, NJ 08701-4582
Phone (513) 487-7479

Other identifiers 1

IdentifierTypeStateIssuer
0771NOtherOHSTATE ID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190220000778 OH Part A Provider - Skilled Nursing Facility 0042558843 Practice locations: Williamsburg, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033689385. Details of each certification follow.

Skilled nursing facility certification: CCN 365336

Legal name
LOCUST RIDGE HEALTHCARE LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 1, 1978
Last certification
Jan 31, 2024
Beds
61
Ownership / control type
Individual
Organization structure
LLCProprietary
Incorporated
Aug 27, 2018 in OH
Enrollment address
12745 Elm Corner Rd
Williamsburg, OH 45176-9621
Nursing home name
LOCUST RIDGE HEALTHCARE LLC
Affiliated entity
CCH HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Locust Ridge Healthcare LLCCCN 365336 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
Mar 1, 1978
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6159.1 residents per day on average
Chain
CCH Healthcare33 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
36D0346238Locust Ridge Healthcare, LLC12745 Elm Corner Rd, Williamsburg, OH 45176Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

12745 Elm Corner Rd
Williamsburg, OH 45176
Phone (513) 579-9949

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Gary L Vannostrand Individual W-2 Managing EmployeeAdministrator Dec 1, 2018 100%
Capital Holdings Trust Organization, Lakewood, NJ 5% Or Greater Indirect Ownership Interest Dec 1, 2018 47.5%
Baruch Jeremias Individual 5% Or Greater Indirect Ownership Interest Dec 1, 2018 50%
Corporate OfficerManager Dec 1, 2018 50%
Corporate DirectorManager Dec 1, 2018 50%
Starlight Healthcare LLC Organization, Lakewood, NJ LLC, For-profit 5% Or Greater Direct Ownership Interest Dec 1, 2018 50%
10-26 Nationwide TR Organization, Lakewood, NJ 5% Or Greater Direct Ownership Interest Dec 1, 2018 50%
Jacob Stern Individual 5% Or Greater Indirect Ownership Interest Dec 1, 2018 2.5%
Corporate OfficerManager Dec 1, 2018 50%
Corporate DirectorManager Dec 1, 2018 50%

Facilities with the same owner 55

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

View all 55

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": "1543449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543449600000",
    "number": "1033689385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 AMERICA AVE UNIT 304",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087014582",
            "telephone_number": "513-487-7479",
            "fax_number": "732-276-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12745 ELM CORNER RD",
            "city": "WILLIAMSBURG",
            "state": "OH",
            "postal_code": "451769621",
            "telephone_number": "937-444-2920",
            "fax_number": "937-444-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOCUST RIDGE HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-29",
        "last_updated": "2018-11-29",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "HAYLEY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "ATTORNEY",
        "authorized_official_telephone_number": "216-706-3936"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE ID",
            "identifier": "0771N",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsburg, OH

Sources for this page

Verify at the official NPI Registry.