NPIMap

Organization Active NPI

Joint Township District Memorial Hospital

Doing business as Grand Lake Hospice

  • Community Based Hospice Care Agency
  • Saint Marys, OH
National Provider Identifier
1215077870
Registry record updated Feb 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
0160HSP Issued in OH
Legal business name
JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL
Doing business as
Grand Lake Hospice
Practice address
1122 E Spring St
Saint Marys, OH 45885-2402
Phone
(419) 394-7434
Fax
(419) 394-6503
NPI assigned
Feb 6, 2007
Last updated
Feb 6, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 6, 2024

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

Authorized official

Name
Tricia Ann Pohl
Title
Cfo
Phone
(419) 394-3387

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 0160HSP OH Primary

Addresses

Primary practice location

1122 E Spring St
Saint Marys, OH 45885-2402

Mailing address

200 Saint Clair Ave
Saint Marys, OH 45885-2400
Phone (419) 394-3335

Other identifiers 1

IdentifierTypeStateIssuer
0160HSPOtherOHSTATE LICENSE

Other names 1

  • Grand Lake Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070412000307 OH Part A Provider - Hospice 3870491590 Practice locations: St Marys, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215077870. Details of each certification follow.

Hospice certification: CCN 361636

Legal name
JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL
Doing business as
GRAND LAKE HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
May 23, 2007
Last certification
May 12, 2022
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Mar 10, 1989 in OH
Enrollment address
1122 E Spring Street
St Marys, OH 45885-2402

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Grand Lake HospiceCCN 361636 · All quality measures
Ownership
Non-Profit
Certified
May 23, 2007
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Joint Township Hospital5 organizations share this tax ID, including this one
Part of
Joint Township Hospital

Other organizations with this tax ID 4

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

Locations

1122 E Spring St
Saint Marys, OH 45885
Phone (419) 394-7434

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Claudia Coe Individual Corporate Director Sep 1, 2017
Randall W. Niekamp Individual Corporate Director Jan 1, 2021
Connie H Meiring Individual Corporate DirectorBoard Member May 1, 2026
Christopher John Stucke Individual Corporate DirectorMember Jan 1, 2024
Joint Township District Memorial Hospital Organization, Saint Marys, OH Non-profit Operational/Managerial Control Oct 18, 2006 100%
Kenneth Lee Fox Individual Corporate Director Jan 1, 2020
Tricia a Pohl Individual Corporate OfficerChief Financial Officer Jan 3, 2022
W-2 Managing EmployeeChief Financial Officer Jan 3, 2022
Robert D Keighley Individual Operational/Managerial ControlHospice Medical Director May 6, 2024
Brian Schlosser Individual Corporate Director Jul 1, 2022
Jeffrey P. Squire Individual Corporate Director Jan 1, 2020
Michael J Boley Individual Corporate DirectorMember Jan 1, 2025
Wally B. Wagner Individual Corporate Director Jan 1, 2020
Cynthia Berning Individual Corporate OfficerPresident and Ceo Dec 16, 2020
Corporate DirectorPresident and Ceo Dec 16, 2020
W-2 Managing EmployeePresident and Ceo Dec 16, 2020
Lana Hinders Individual Operational/Managerial ControlCno/Hospice Administrator May 6, 2024

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Vancrest of St Mary'sSaint Marys, OH, CCN 365232 Skilled nursing facility 5% Or Greater Direct Ownership Interest (25%) Oct 16, 2019
Grand Lake Home HealthSaint Marys, OH, CCN 367405 Home health agency Operational/Managerial Control Jan 1, 1990

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Affiliated clinicians 7

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": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707177600000",
    "number": "1215077870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 SAINT CLAIR AVE",
            "city": "SAINT MARYS",
            "state": "OH",
            "postal_code": "458852400",
            "telephone_number": "419-394-3335",
            "fax_number": "419-394-8485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 E SPRING ST",
            "city": "SAINT MARYS",
            "state": "OH",
            "postal_code": "458852402",
            "telephone_number": "419-394-7434",
            "fax_number": "419-394-6503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL",
        "enumeration_date": "2007-02-06",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A",
        "authorized_official_last_name": "POHL",
        "authorized_official_first_name": "TRICIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "419-394-3387"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "OH",
            "license": "0160HSP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "0160HSP",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Lake Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grand Lake Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Marys, OH

Sources for this page

Verify at the official NPI Registry.