NPIMap

Organization Active NPI

Embassy Willard LLC

Doing business as Embassy of Willard

  • Skilled Nursing Facility
  • Willard, OH
National Provider Identifier
1184492894
Registry record updated Dec 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EMBASSY WILLARD LLC
Doing business as
Embassy of Willard
Practice address
370 E Howard St
Willard, OH 44890-1656
Phone
(419) 935-0148
NPI assigned
Dec 13, 2023
Last updated
Dec 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2023

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

Authorized official

Name
Penny Kinicki
Title
Director of Contracting
Phone
(216) 378-2050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

370 E Howard St
Willard, OH 44890-1656

Mailing address

25201 Chagrin Blvd Ste 190
Beachwood, OH 44122-5633
Phone (316) 378-2050

Other names 1

  • Embassy of Willard Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240213000750 OH Part A Provider - Skilled Nursing Facility 0547603961 Practice locations: Willard, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184492894. Details of each certification follow.

Skilled nursing facility certification: CCN 365343

Legal name
EMBASSY WILLARD LLC
Doing business as
EMBASSY OF WILLARD
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 27, 1976
Last certification
Apr 25, 2024
Beds
59
Ownership / control type
Corporation
Multi-facility organization
EMBASSY HEALTHCARE
Most recent change of ownership
Jan 1, 2024
Organization structure
LLCProprietary
Enrollment address
370 E Howard St
Willard, OH 44890-1656
Nursing home name
EMBASSY OF WILLARD
Affiliated entity
EMBASSY HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Embassy of WillardCCN 365343 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Sep 27, 1976
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5955.8 residents per day on average
Chain
Embassy Healthcare33 facilities in the chain
Penalties (3 years)
1Fines totaling $17,655

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Embassy of Willard2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

370 E Howard St
Willard, OH 44890
Phone (419) 935-0148

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
Ah Dynasty LLC Organization, Beachwood, OH LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 50%
Mollie Snook Individual W-2 Managing EmployeeAdministrator Jan 1, 2024
Nicholas Ciccone Individual Corporate OfficerGeneral Counsel Jan 1, 2024
OtherTrustee of Trust Jan 1, 2024
Aaron B Handler Individual Corporate OfficerVice President Jan 1, 2024
George S. Repchick Individual Corporate OfficerPresident Jan 1, 2024
2020 GSR Dynasty LLC Organization, Beachwood, OH LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 50%
Embassy Healthcare Holdings Inc Organization, Beachwood, OH Corporation, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2024 100%

Facilities with the same owner 31

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

View all 31

Practitioners & affiliated clinicians

Practitioners 1

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": "1702425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702425600000",
    "number": "1184492894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25201 CHAGRIN BLVD STE 190",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225633",
            "telephone_number": "316-378-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 E HOWARD ST",
            "city": "WILLARD",
            "state": "OH",
            "postal_code": "448901656",
            "telephone_number": "419-935-0148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBASSY WILLARD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-13",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A",
        "authorized_official_last_name": "KINICKI",
        "authorized_official_first_name": "PENNY",
        "authorized_official_title_or_position": "DIRECTOR OF CONTRACTING",
        "authorized_official_telephone_number": "216-378-2050"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Embassy of Willard",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Willard, OH

Sources for this page

Verify at the official NPI Registry.