Organization Active NPI

Vancrest of Upper Sandusky LLC

Doing business as Vancrest of Upper Sandusky

  • Skilled Nursing Facility
  • Upper Sandusky, OH
National Provider Identifier
1093404857
Registry record updated Aug 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
VANCREST OF UPPER SANDUSKY LLC
Doing business as
Vancrest of Upper Sandusky
Practice address
890 Marseilles Ave
Upper Sandusky, OH 43351-1648
Phone
(419) 294-4973
Fax
(419) 294-4975
NPI assigned
May 5, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2026

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

Authorized official

Name
Edgar Silalahi
Title
Cfo
Phone
(419) 238-0715

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

890 Marseilles Ave
Upper Sandusky, OH 43351-1648

Mailing address

890 Marseilles Ave
Upper Sandusky, OH 43351-1648
Phone (419) 294-4973

Other identifiers 2

IdentifierTypeStateIssuer
1116NOtherOHLICENSURE
0017837MedicaidOH

Other names 1

  • Vancrest of Upper Sandusky Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230809001777 OH Part A Provider - Skilled Nursing Facility 3678935574 Practice locations: Upper Sandusky, OH

Skilled nursing facility certification: CCN 365478

Legal name
VANCREST OF UPPER SANDUSKY LLC
Doing business as
VANCREST OF UPPER SANDUSKY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 3, 1980
Last certification
Oct 26, 2023
Beds
99
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Vancrest Healthcare
Organization structure
LLCProprietary
Incorporated
Jan 20, 2023 in OH
Enrollment address
850 Marseilles Ave
Upper Sandusky, OH 43351-1648
Nursing home name
VANCREST OF UPPER SANDUSKY
Affiliated entity
VANCREST HEALTH CARE CENTERS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Vancrest of Upper SanduskyCCN 365478 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Apr 3, 1980
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9990.4 residents per day on average
Chain
Vancrest Health Care Centers13 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
36D0682181Vancrest of Upper Sandusky850 Marseilles Ave, Upper Sandusky, OH 43351Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

890 Marseilles Ave
Upper Sandusky, OH 43351

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
Jon D Bagley Individual 5% Or Greater Direct Ownership Interest Jun 1, 2023 15%
Corporate OfficerVice President Jun 1, 2023 33.3%
Corporate DirectorDirector Jun 1, 2023 50%
Nicolaus White Individual 5% Or Greater Direct Ownership Interest Jun 1, 2023 10%
Mark Stuart McCleery Individual 5% Or Greater Direct Ownership Interest Jun 1, 2023 5%
Corporate OfficerCeo and Treasurer Jun 1, 2023 33.3%
Claire White Individual 5% Or Greater Direct Ownership Interest Jun 1, 2023 10%
Jean Smith Individual W-2 Managing EmployeeAdministrator Jun 1, 2023 100%
Mark a White Individual 5% Or Greater Direct Ownership Interest Jun 1, 2023 42%
Corporate OfficerPresident Jun 1, 2023 33.3%
Corporate DirectorDirector Jun 1, 2023 33.3%
Mark L Myers Individual 5% Or Greater Direct Ownership Interest Jun 1, 2023 8%

Practitioners & affiliated clinicians

Practitioners 1

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": "1683244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786924800000",
    "number": "1093404857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "890 MARSEILLES AVE",
            "city": "UPPER SANDUSKY",
            "state": "OH",
            "postal_code": "433511648",
            "telephone_number": "419-294-4973",
            "fax_number": "419-294-4975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 MARSEILLES AVE",
            "city": "UPPER SANDUSKY",
            "state": "OH",
            "postal_code": "433511648",
            "telephone_number": "419-294-4973",
            "fax_number": "419-294-4975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANCREST OF UPPER SANDUSKY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-05",
        "last_updated": "2026-08-17",
        "certification_date": "2026-08-17",
        "status": "A",
        "authorized_official_last_name": "SILALAHI",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "419-238-0715"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSURE",
            "identifier": "1116N",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017837",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vancrest of Upper Sandusky",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Upper Sandusky, OH

Sources for this page

Verify at the official NPI Registry.