Bryan Healthcare and Rehabilitation Center LLC
Organization Active NPI Skilled Nursing Facility · Bryan, OH
NPI 1043976798 · NPPES record last updated Nov 16, 2021
Key facts
- NPI
- 1043976798
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- BRYAN HEALTHCARE AND REHABILITATION CENTER LLC
- Practice address
- 1104 Wesley Ave
Bryan, OH 43506-2579 - Phone
- (419) 636-5071
- NPI assigned
- Nov 16, 2021
- Organization subpart
- No
Authorized official
- Name
- Jason Dipasqua
- Title
- Coo
- Phone
- (330) 720-0406
Facilities with the same owner 6
Practitioners 1
-
Robert Raymond Daiber, M.D.
Affiliated clinicians 1
-
Robert Raymond Daiber, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Majestic Care of Bryan
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Mar 28, 1991
- Medicare certification status
- Active
- Certified beds
- 149 · 66.6 residents per day on average
- Penalties (3 years)
- 3 · fines totaling $74,055
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D0669601 | Bryan Healthcare and Rehabilitation | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Skilled nursing facility certification: CCN 365830
- Legal name
- BRYAN HEALTHCARE AND REHABILITATION CENTER LLC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 28, 1991
- Last certification
- Mar 21, 2024
- Beds
- 149
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Majestic Care LLC
- Most recent change of ownership
- Dec 31, 2024
- Organization structure
- LLC · Proprietary
- Incorporated
- Jul 14, 2021 in OH
- Enrollment address
- 1104 Wesley Ave
Bryan, OH 43506-2579
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Shmuel Fishman |
5% Or Greater Indirect Ownership Interest |
Dec 28, 2021 | 27.5% |
| Corporate Officer |
Dec 28, 2021 | 50% | |
| Corporate Director |
Dec 28, 2021 | 50% | |
| Joseph Orgel |
5% Or Greater Indirect Ownership Interest | Dec 28, 2021 | 25% |
| Pwo Partners LLC |
5% Or Greater Indirect Ownership Interest | Dec 28, 2021 | 5% |
| Nicole Giesige |
W-2 Managing Employee |
Dec 28, 2021 | 100% |
| Jason Dipasqua |
5% Or Greater Indirect Ownership Interest |
Dec 28, 2021 | 22.5% |
| Corporate Officer |
Dec 28, 2021 | 50% | |
| Corporate Director |
Dec 28, 2021 | 50% | |
| Joel Zupnick |
5% Or Greater Indirect Ownership Interest | Dec 28, 2021 | 16% |
| CHM Oh West Opco Holdco LLC |
5% Or Greater Direct Ownership Interest | Dec 28, 2021 | 100% |
| Joel Leifer |
5% Or Greater Indirect Ownership Interest | Dec 28, 2021 | 8% |
| Ohio Care SKLD LLC |
5% Or Greater Indirect Ownership Interest | Dec 28, 2021 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220223001375 | OH | Part a Provider - Skilled Nursing Facility | 9133513856 | Practice locations: Bryan, OH |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
1104 Wesley Ave
Bryan, OH 43506-2579
Mailing address
555 Anthony Wayne TRL
Waterville, OH 43566-1516
Phone (330) 720-0406
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1616N | Other | OH | LICENSURE |
Other names
- Bryan Healthcare and Rehabilitation Center
- SKLD Bryan
Other providers in Bryan, OH
- Gary Brown
- Sabrina Brown
- Rhonda Bruot
- Bryan City School District
- Bryan Eye Center PC
- Bryan Oh Health & Rehab Opco LLC
- Bryan Reading Clinic
- Bryan SNF, LLC
- Jakob Buchanan
- Andrew Dwight Buckland
All providers in Bryan, 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 Nov 16, 2021. 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.