Active NPI
Willow Brook Christian Services
Doing business as Willow Brook Christian Home
- Skilled Nursing Facility
- Columbus, OH
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 1315N
- Legal business name
- WILLOW BROOK CHRISTIAN SERVICES
- Doing business as
- Willow Brook Christian Home
- Practice address
- 55 Lazelle Rd
Columbus, OH 43235-1419 - Phone
- (614) 885-3300
- Fax
- (614) 885-8476
- NPI assigned
- Jan 23, 2006
- 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
- Mrs. Terry G Martini
- Title
- Director of Finance
- Phone
- (740) 368-4621
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 1315N | OH | Primary |
Addresses
Primary practice location
55 Lazelle Rd
Columbus, OH 43235-1419
Mailing address
100 Willow Brook Way S
Delaware, OH 43015
Phone (740) 369-0048
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2492388 | Medicaid | OH |
Other names 1
- Willow Brook Christian Home
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040730000762 | OH | Part A Provider - Skilled Nursing Facility | 4486624970 | Practice locations: Columbus, OH |
Skilled nursing facility certification: CCN 365988
- Legal name
- WILLOW BROOK CHRISTIAN SERVICES
- Doing business as
- WILLOW BROOK CHRISTIAN HOME
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 16, 1995
- Last certification
- Nov 7, 2024
- Beds
- 50
- Ownership / control type
- Nonprofit Corporation
- Multi-facility organization
- Willow Brook Christian Services
- Organization structure
- Corporation
- Incorporated
- Apr 12, 2004 in OH
- Enrollment address
- 55 Lazelle Rd
Columbus, OH 43235-1402 - Nursing home name
- WILLOW BROOK CHRISTIAN HOME
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Cherith Care Center
- Skilled Nursing Facility
- Delaware, OH
- NPI 1811967078
4486624970
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Willow Brook Christian Home
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Jan 16, 1995
- Medicare certification status
- Active
- Certified beds
- 50
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 |
|---|---|---|---|
| 36D0330534 | Willow Brook Christian Home | Certificate of waiver | Aug 31, 2026 |
| 36D2284394 | Willow Brook Christian Home | Certificate of waiver | Jun 21, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- Willow Brook Christian Services
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Willow Brook By Day
- Adult Day Care Clinic/Center
- Delaware, OH
- NPI 1376094383
Ownership & related parties
All disclosed owners & managing parties 17
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 |
|---|---|---|---|
| Scott Longo | Corporate Director | Mar 10, 2007 | |
| Neil E Richard | Adp of the SNF | Mar 1, 2016 | |
| Nicole Ketron | Operational/Managerial Control | Jan 1, 2005 | |
| Adp of the SNF | Jun 24, 2025 | ||
| Thomas Poulson | Corporate Officer | Jun 28, 2010 | |
| Adp of the SNF | Jun 28, 2010 | ||
| Michael a. Ringle | Corporate Director | Apr 26, 2025 | |
| Matthew Troy McKnight | Corporate Officer | Jan 9, 2023 | |
| Operational/Managerial Control | Jan 9, 2023 | ||
| Adp of the SNF | Jan 9, 2023 | ||
| Terry Lee Irwin | Corporate Director | Jan 1, 2005 | |
| William Johnson | Corporate Director | Nov 14, 2019 | |
| Brandi Davis | Corporate Director | Jan 11, 2024 | |
| Blythe McKenna | Corporate Director | Jan 23, 2025 | |
| Roger Pickens | Corporate Director | Nov 8, 2012 | |
| Peggy Tidwell | Corporate Director | Mar 16, 2013 | |
| Jerry May | Corporate Director | Jul 24, 2025 | |
| Ed Sarkel | Corporate Director | May 9, 2019 | |
| Kent Harris | Operational/Managerial Control | Dec 10, 2025 | |
| Adp of the SNF | Dec 10, 2025 | ||
| Karen Susenna | Corporate Director | Nov 9, 2017 | |
| Phil Barth | Corporate Director | Aug 16, 2004 |
Owners & managing parties with NPI records 2
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
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
- Westerville, OH
- NPI 1801865670
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137974400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1346210515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 WILLOW BROOK WAY S",
"city": "DELAWARE",
"state": "OH",
"postal_code": "43015",
"telephone_number": "740-369-0048",
"fax_number": "740-368-4630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 LAZELLE RD",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432351419",
"telephone_number": "614-885-3300",
"fax_number": "614-885-8476"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WILLOW BROOK CHRISTIAN SERVICES",
"organizational_subpart": "NO",
"enumeration_date": "2006-01-23",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "MARTINI",
"authorized_official_first_name": "TERRY",
"authorized_official_middle_name": "G",
"authorized_official_title_or_position": "DIRECTOR OF FINANCE",
"authorized_official_telephone_number": "740-368-4621",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "OH",
"license": "1315N",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2492388",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Willow Brook Christian Home",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.