NPIMap

Organization Active NPI

Oak Grove Manor Operating Company LLC

  • Skilled Nursing Facility
  • Mansfield, OH
National Provider Identifier
1174149504
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
OAK GROVE MANOR OPERATING COMPANY LLC
Practice address
1670 Crider Rd
Mansfield, OH 44903-9268
Phone
(419) 589-6222
NPI assigned
Jun 22, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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

Authorized official

Name
Mr. Jeffrey Degyansky, LNHA
Title
Vice President of Operations
Phone
(330) 620-7828

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1670 Crider Rd
Mansfield, OH 44903-9268

Mailing address

5915 Landerbrook Dr Ste 350
Mayfield Heights, OH 44124-4063
Phone (330) 620-7828

Other identifiers 1

IdentifierTypeStateIssuer
1783NOtherOHLICENSURE

Other names 1

  • Oak Grove Manor Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200828001377 OH Part A Provider - Skilled Nursing Facility 0345667820 Practice locations: Mansfield, OH

Skilled nursing facility certification: CCN 365837

Legal name
OAK GROVE MANOR OPERATING COMPANY LLC
Doing business as
OAK GROVE MANOR
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 6, 1991
Last certification
May 16, 2024
Beds
75
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Lionstone Care Management
Organization structure
LLCProprietary
Incorporated
Apr 27, 2020 in OH
Enrollment address
1670 Crider Rd
Mansfield, OH 44903-9268
Nursing home name
OAK GROVE MANOR
Affiliated entity
LIONSTONE CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Oak Grove ManorCCN 365837
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 6, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7571.6 residents per day on average
Chain
Lionstone Care24 facilities in the chain
Penalties (3 years)
1Fines totaling $15,593

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Solomon Kazarnovsky Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2023 50%
Corporate OfficerCo Manager Jan 1, 2023
Eliezer Goldish Individual Corporate OfficerChief Financial Officer Oct 9, 2023
Operational/Managerial Control Oct 9, 2023
Adp of the SNF Oct 9, 2023
Individual Adp of the SNF Jan 13, 2025
Adam Cusner Individual Corporate OfficerChief Executive Officer Jan 27, 2025
Operational/Managerial Control Jan 27, 2025
Adp of the SNF Jan 27, 2025
Individual Adp of the SNF Oct 1, 2023
Jeffrey Degyansky Individual Corporate OfficerChief Operating Officer Jan 1, 2020
Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023
Lionstone HZ Opco Holdings LLC Organization, Valley Stream, NY LLC, Holding company 5% Or Greater Direct Ownership Interest Jan 1, 2023 100%
Abba Stein Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2023 50%
Corporate OfficerCeo and Co Manager Jan 1, 2023
Operational/Managerial Control Jan 1, 2023

Facilities with the same owner 9

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1592784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1174149504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5915 LANDERBROOK DR STE 350",
            "city": "MAYFIELD HEIGHTS",
            "state": "OH",
            "postal_code": "441244063",
            "telephone_number": "330-620-7828",
            "fax_number": "216-428-2055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 CRIDER RD",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449039268",
            "telephone_number": "419-589-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK GROVE MANOR OPERATING COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-22",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "DEGYANSKY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "VICE PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "330-620-7828",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LNHA"
    },
    "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": "1783N",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oak Grove Manor",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Oak Grove Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mansfield, OH

Sources for this page

Verify at the official NPI Registry.