Active NPI
Vancrest of Upper Sandusky LLC
Doing business as Vancrest of Upper Sandusky
- Skilled Nursing Facility
- Upper Sandusky, OH
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1116N | Other | OH | LICENSURE |
| 0017837 | Medicaid | OH |
Other names 1
- Vancrest of Upper Sandusky
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- LLC
- 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 Sandusky
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Apr 3, 1980
- Medicare certification status
- Active
- Certified beds
- 99
- Chain
- Vancrest Health Care Centers
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D0682181 | Vancrest of Upper Sandusky | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryLocations
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Jon D Bagley | 5% Or Greater Direct Ownership Interest | Jun 1, 2023 | 15% |
| Corporate Officer | Jun 1, 2023 | 33.3% | |
| Corporate Director | Jun 1, 2023 | 50% | |
| Nicolaus White | 5% Or Greater Direct Ownership Interest | Jun 1, 2023 | 10% |
| Mark Stuart McCleery | 5% Or Greater Direct Ownership Interest | Jun 1, 2023 | 5% |
| Corporate Officer | Jun 1, 2023 | 33.3% | |
| Claire White | 5% Or Greater Direct Ownership Interest | Jun 1, 2023 | 10% |
| Jean Smith | W-2 Managing Employee | Jun 1, 2023 | 100% |
| Mark a White | 5% Or Greater Direct Ownership Interest | Jun 1, 2023 | 42% |
| Corporate Officer | Jun 1, 2023 | 33.3% | |
| Corporate Director | Jun 1, 2023 | 33.3% | |
| Mark L Myers | 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.
-
- Family Medicine Physician
- Prospect, OH
- NPI 1568478626
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
- United Church Homes, Inc. (Fairhaven Community)
- Upper Sandusky Exempted Village School District
- Upper Sandusky Medical Assoc Inc
- Usc&LC LLC (Upper Sandusky Counseling & Life Coaching)
- Jose Vale, MD
- Vancrest of Upper Sandusky LLC
- Vanhoose Upper Sandusky Dental (Upper Sandusky Dental)
- Chevone R Vent, MD
- Heidi Lenore Vent
- Diane E Vonstein, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.