NPIMap

Organization Active NPI

Edgewood Manor of Lucasville I LLC

  • Skilled Nursing Facility
  • Lucasville, OH
National Provider Identifier
1083132914
Registry record updated Aug 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EDGEWOOD MANOR OF LUCASVILLE I LLC
Practice address
10098 Big Bear Creek Rd
Lucasville, OH 45648-9168
Phone
(740) 289-5536
NPI assigned
Aug 30, 2017
Last updated
Aug 30, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2017

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

Authorized official

Name
Alexander Sherman
Title
Managing Member
Phone
(718) 688-8760

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

10098 Big Bear Creek Rd
Lucasville, OH 45648-9168

Mailing address

1535 Rockaway Pkwy
Brooklyn, NY 11236-4001

Other identifiers 1

IdentifierTypeStateIssuer
1761NOtherOHODH HOME NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180510000489 OH Part A Provider - Skilled Nursing Facility 7517221930 Practice locations: Lucasville, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083132914. Details of each certification follow.

Skilled nursing facility certification: CCN 365585

Legal name
EDGEWOOD MANOR OF LUCASVILLE I LLC
Doing business as
EDGEWOOD MANOR OF LUCASVILLE I
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 16, 1982
Last certification
May 9, 2024
Beds
99 (96 certified)
Ownership / control type
Limited Liability Corporation
Multi-facility organization
AOM Healthcare
Organization structure
LLCProprietary
Incorporated
Jul 19, 2017 in OH
Enrollment address
10098 Big Bear Creek Rd
Lucasville, OH 45648-9168
Nursing home name
EDGEWOOD MANOR OF LUCASVILLE I
Affiliated entity
AOM HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Edgewood Manor of Lucasville ICCN 365585 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Aug 16, 1982
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9688.6 residents per day on average
Chain
Aom Healthcare20 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Zalman Wagschal Individual 5% Or Greater Indirect Ownership Interest Sep 18, 2017 16%
Samuel Sherman Individual 5% Or Greater Direct Ownership Interest Jan 15, 2024 20.5%
Corporate OfficerMember Sep 18, 2017
Jeffery Goldstein Individual 5% Or Greater Direct Ownership Interest Jan 15, 2024 20.5%
Corporate OfficerMember Sep 18, 2017
Serenity Equity Holdings LLC Organization, Brooklyn, NY Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Sep 18, 2017 16%
Thomas Barr Individual W-2 Managing EmployeeAdministrator Sep 18, 2017
David Weinberger Individual 5% Or Greater Indirect Ownership Interest Sep 18, 2017 5%
Alexander Sherman Individual 5% Or Greater Direct Ownership Interest Jan 15, 2024 17%
Corporate OfficerMember Sep 18, 2017
Zaleman Horowitz Individual 5% Or Greater Indirect Ownership Interest Sep 18, 2017 7.2%
ZW Aom Re LLC Organization, Brooklyn, NY Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Sep 18, 2017 16%
Aom Healthcare LLC Organization, Brooklyn, NY LLC Operational/Managerial Control Sep 18, 2018

Facilities with the same owner 8

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, 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": "1504051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504051200000",
    "number": "1083132914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 ROCKAWAY PKWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112364001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10098 BIG BEAR CREEK RD",
            "city": "LUCASVILLE",
            "state": "OH",
            "postal_code": "456489168",
            "telephone_number": "740-289-5536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD MANOR OF LUCASVILLE I LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-30",
        "last_updated": "2017-08-30",
        "status": "A",
        "authorized_official_last_name": "SHERMAN",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "718-688-8760"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ODH HOME NUMBER",
            "identifier": "1761N",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lucasville, OH

Sources for this page

Verify at the official NPI Registry.